Forms

 

**If you have any dental concerns or feel this is a dental emergency, please click here**

 

Transfer of Records/Release of Information

This form is required by our practice to verify that we have your permission to release your child's dental records.

After completing this form, you can e-mail or mail it or bring the form to the office where your child is usually seen.

*******Please allow 3 to 5 business days to process this request.*******

Parent/Legal Guardian Consent for Dental Treatment

A parent or legal guardian MUST accompany any child under 18 to all appointments. If a parent or legal guardian cannot accompany the child, a Consent for Dental Treatment Form must be completed and sent along to the appointment.

The Consent for Dental Treatment Form gives a child's caregiver, who is not the parent/legal guardian, permission to consent to dental treatment for your child(ren). This form must be presented when anyone other than the parent or legal guardian will accompany your child(ren) to our practice.

*IMPORTANT: You must complete all information requested on our authorization form, or we may be unable to treat your child(ren).

*IMPORTANT: Remember to send along this completed form any time your child is seen by someone other than the parent or legal guardian at our practice.

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