Patient Forms

Download and complete forms prior to appointment. This will save time at your first visit.

All patient information is confidential.

Patient Medical History Form and Office Policy Agreement.

HIPAA Consent Form. We respect the confidentiality of all records. Please download and bring this form with you.

If you have dental insurance, please download the insurance verification form and and provide details of both primary and secondary policy information.

PRIVACY

HIPAA compliance information for patient review.

Go Paperless

Call to set up your electronic chart.

CALL 713-461-1116

Schedule Your Appointment

We will send login info to your electronic chart.

SCHEDULE APPOINTMENT

Download and complete forms prior to appointment. This will save time at your first visit.

Go Paperless

Call to set up your electronic chart.

Schedule Your Appointment

We will send login info to your electronic chart.

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