Appointment forms
Filling these in before you arrive means less time at the front desk and more time with your dentist. Bring them with you, or send them ahead.
Complete the forms below, in English or Spanish
Bring a list of any medications you take
Bring photo identification
Ask a previous dentist to forward recent X-rays
Download your forms
Print them, fill them in by hand, and bring them to your first appointment. Every form is available in English and Spanish.
Patient registration
Your contact details and an emergency contact.
Medical history
Allergies, medications and health conditions that affect your treatment.
HIPAA privacy acknowledgement
Confirms you have received our Notice of Privacy Practices, and how you would like us to contact you.
Authorization, release and agreement
Please read, sign and date before your first visit.
Cancellation and no-show policy
How much notice we need if you have to change an appointment.
Sending them back
Bring them with you
The simplest option. Arrive a few minutes early and hand them to the receptionist.
970-807-0052
A fax line is a secure way to send health information ahead of your appointment.
970-816-6118
Call if anything on the form is unclear, or if you would rather go through it with us.
Please do not email completed forms or send them through the contact form on this site. Neither is a secure channel for health information. Bring them in, fax them, or call us and we will arrange it.
Ready when you are.
Call the practice or send us a message and we will find you an appointment.