Forms

This form authorizes the secure processing of your credit card payment for specified transactions.

This form authorizes the release of a patients medical records to our office, detailing the information to be shared and ensuring consent for disclosure.

This form authorizes the release of Patient X-ray images and related records to designated recipients and allows Patients to request additional X-ray examinations as needed.

This form explains graft options, risks, and healing factors so you can make an informed choice—read, ask questions, then sign before surgery.

Outlines the procedure, healing expectations, and risks. Read, clarify any concerns, then sign to authorize treatment.

Explains why a bridge is advised, key risks (sensitivity, root-canal or gum surgery, bite changes), and the need to finish treatment and maintain good oral care—read, clarify, sign.

Explains why a crown is needed, outlines possible risks (sensitivity, root-canal or gum surgery, bite changes), and confirms your agreement to proceed. Read, clarify concerns, then sign.

Approves treatment and anesthesia, notes risks and payment terms, and authorizes insurance billing; read, clarify, sign.

Explains root-canal purpose, success rate, key risks (instrument breakage, infection, retreatment or extraction) and need for a timely crown/filling—read, clarify questions, then sign.

Explains purpose and risks of tooth extraction—from pain and infection to rare nerve effects—and confirms post-op care; read, ask questions, then sign.

Explains how we handle claims (work plans, JP, NIHB, multiple insurers), assign benefits to us, and notes you’re responsible for any balance—read, ask questions, then sign.

Outlines the gum-graft procedure, potential risks, and required follow-up; review, ask questions, then sign.

Two-page implant consent outlining treatment, alternatives, risks, follow-up duties, photo release, and signature lines for patient, providers, and witness.