Patient Forms

We are a, "Green Office", paperless office so we highly encourage everyone to fill out the online forms.

We provide online copies of our forms and informational documents.We also have an electronic submission form for health history and financial information.

If you already have an appointment, please complete this secure online form to save time and paper: Secure Online Form

If you already have an account, please log in here.

Please review and complete the following forms prior to your child's first visit:

• Privacy Practices and Dental Materials Fact Sheet
• Parent Information / Agreement
• Consent for Dental Treatment
• Insurance Policy Form
• Health History Form (or you can complete the secure online form)
  

NOTE: All of the paper documents require Adobe Acrobat Reader and a printer.

 

All information collected is directly transmitted to a secure email account and is not kept on a public web server. Information is used solely for appointment scheduling and patient contact and is not shared or sold under any circumstances. If you have any concern regarding the confidentiality of your information, please call our office directly or email us at info@littlesmilesoc.com