Patient Forms
Please click on the links below to securely complete and submit our online forms prior to your child's appointment. Be sure to bring your child's insurance card to your appointment. If you cannot submit the forms before your child's appointment, please plan to arrive in 10-15 minutes so that you may complete them in our office. If you have any questions, please call our office at 845-360-5883.
New Patient Forms
Health History Form
Office Policies
HIPAA Acknowledgment Form
Consent for Pediatric Dental Procedures
Explanation of Treatment
"Boss of My Finger" Form
Informed Consent Form for Extractions
Informed Consent Form for SDF
Informed Consent Form for Nitrous Oxide
Informed Consent Form for Dental Sedation
Delegation of Power by Parent / Legal Guardian
Voluntary Election to Decline Diagnostic X-rays & Liability Waiver