Patient Forms

You may access the following forms to assist us with your care. Please complete the following forms, and click the "Submit" button at the bottom of each form.

Online Forms

• New Patient Form (Child)
• New Patient Form (Adult)
• Covid-19 Supplemental Informed Consent
• Covid-19 Supplemental Health Questionnaire

*We are committed to keeping your personal information secure. All of our online forms are submitted via a secure connection and are HIPAA compliant.

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You may access the following forms to assist us with your care. Please print and fill out the following forms, then bring them to your appointment.

Printable Forms

• New Patient Form (Child)
• New Patient Form (Adult)
• Informed Consent
• Certificate of Routine Dental Cleaning
• Notice of Privacy Practices - English
• Notice of Privacy Practices - Spanish
• Signature Form for Privacy Practices
• LCO COVID-19 Questionnaire 5-20-20
• LCO COVID-19 Informed Consent 5-20-20

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*These printable forms require Adobe Acrobat Reader. Click the Adobe logo to download.