Print and Fill Out Patient Registration Forms

>>>>> NEW PATIENT REGISTRATION FORMS - Download

* All NEW PATIENTS, kindly fill out ALL NEW PATIENT FORMS and bring to your FIRST VISIT ~ Thank You!

* ALL CURRENT PATIENTS - NEW UPDATED HIPAA FORM, kindly fill out the New Updated Hipaa Form below and please bring with you to your next visit ~ Thank You!

>>>>> NEW UPDATED HIPAA for CURRENT PATIENTS - Download

>>>>> PATIENT ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES AND CONSENT - Download

>>>>> DENTAL HEALTH CERTIFICATE - NYS - (SCHOOL) Optional Download


The following HIPAA Form is ONLY for Referral of Health Information to be Released to another Provider or Specialist

Please Note: The complete OMNIBUS Rule HIPAA NOTICE OF PRIVACY PRACTICES is available under the OMNIBUS Rule Section under Insurance & Patient Forms Category

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HOURS OF OPERATION

Find Out When We Are Open

Monday:

8:00 am-5:00 pm

Tuesday:

8:00 am-5:00 pm

Wednesday:

8:00 am-4:00 pm

Thursday:

8:00 am-5:00 pm

Friday:

Emergency Phone Line Only

Saturday:

Emergency Phone Line Only

Sunday:

Emergency Phone Line Only