New Patient Forms

Information for New Patients

Your first visit at Lake Park Family and Cosmetic Dentistry involves a few special steps so that we can get to know you. This will include completing new patient paperwork. For your conveniece we have attached the forms below. You are welcome to print and complete these forms prior to your first appointment to expedite your check-in process more quickly. If you need assistance with forms we will be glad to assist you when you get to the office for your scheduled appointment.

For your convenience we do accept VISA, Mastercard, Discover, debit cards or cash. We do not accept checks. We do offer interest free financing through Citi Health card (www.healthcard.citicards.com). We also accept CareCredit. If you need assistance with securing financing please give us a call and we will assist you.

(In order to view or print these forms you will need Adobe Acrobat Reader installed.)

Medical History

Registration

Disclaimer Form

HIPAA Authorization

HIPAA Privacy Practices 1

HIPAA Privacy Practices 2

HIPAA Privacy Practices 3

Join Our Email List Today!