New Patient Forms

Harrisburg Dentist

In order to provide you with the most efficient new patient experience, please download and complete the forms that apply below and bring them to your first appointment.  This will allow the new patient process to run quicker and smoother for both our practice and you.

Our team will take comprehensive records and address any concerns or questions you may have.  If you are having problems downloading the forms, please contact our office and we will gladly send them to you.

New Patient Registration
Medical History
Authorization for Release of Information – Compound Release
Acknowledgment of Receipt of Notice of Privacy Practices

Please fill out the following forms if applicable:
Authorization to Release Health Information
Patient Photo Release Form