New Patients: (801) 685-1197 | Current Patients: (801) 298-1812

Patient Forms

  • Ask The Doctor

 Your First Visit & Patient Forms

Welcome to our holistic dental practice. You have probably noticed that we do things a bit differently than dental offices you have visited in the past. We approach dentistry with a total body health perspective. For this reason, our diagnostic testing is VERY thorough, and the information you provide is ABSOLUTELY critical!

Please complete the forms below (depending on what type of treatment you are seeking). You may either print and complete a hard copy, or you may digitally enter your information and have it securely submitted to our office. If you should encounter any difficulty completing these forms, please call our office for assistance.

Welcome! (Read First)

New Patient General Dentistry Forms

1. Demographics: Download PDF or Fill Out Online

2. Financial Policy: Download PDF or Fill Out Online

3. Privacy Practices: Download PDF or Fill Out Online

4. Limited Records: Download PDF or Fill Out Online

5. Health History: Download PDF or Fill Out Online

6. Symptom Survey: Download PDF or Fill Out Online

7. Photo Release: Download PDF or Fill Out Online

8. Cancellation Policy: Download PDF or Fill Out Online

New Patient TMJ Forms

1. Craniofacial Pain Therapy

2. Demographics: Download PDF or Fill Out Online

3. Financial Policy: Download PDF or Fill Out Online

4. Privacy Practices: Download PDF or Fill Out Online

5. TMJ Health History: Download PDF or Fill Out Online

6. TMJ Records: Download PDF or Fill Out Online

7. TMJ Scale: Download PDF or Fill Out Online

8. TMJ Options: Download PDF or Fill Out Online

9. Cancellation Policy: Download PDF or Fill Out Online

New Patient Sleep Forms

1. Demographics: Download PDF or Fill Out Online

2. Financial Policy: Download PDF or Fill Out Online

3. Privacy Practices: Download PDF or Fill Out Online

4. Sleep Questions: Download PDF or Fill Out Online

5. Sleep Health History: Download PDF or Fill Out Online

6. Sleep Package: Download PDF or Fill Out Online

7. Photo Release: Download PDF or Fill Out Online

8. Symptom Survey: Download PDF or Fill Out Online

9. Cancellation Policy: Download PDF or Fill Out Online

Patient Information

1. ALF (Advanced Lightwire Functional) Appliance: Download PDF

2. Recommended Dietary Instructions: Download PDF

3. Foods For Dental Revision Patients: Download PDF

4. Microcurrent: Download PDF

5. The Basic Nutritional Experiment: Download PDF

6. Orthotic Care: Download PDF

7. What is “Periodontal Therapy”: Download PDF

8. Weaning Instructions: Download PDF

Informed Consents

1. ALF (Advanced Lightwire Functional) Consent : Download PDF or Fill Out Online

2. Alternative Therapy Consent: Download PDF or Fill Out Online

3. Amalgam/Metal Removal Informed Consent: Download PDF or Fill Out Online

4. Consent for Biopsy: Download PDF or Fill Out Online

5. Teeth Whitening Informed Consent: Download PDF or Fill Out Online

6. Cavitat Scan Consent: Download PDF or Fill Out Online

7. Affidavit for Intolerance to CPAP: Download PDF or Fill Out Online

8. Dentures Informed Consent: Download PDF or Fill Out Online

9. Diagnostic Testing Consent: Download PDF or Fill Out Online

10. Oral Surgery Informed Consent: Download PDF or Fill Out Online

11. Zirconia Implants Consent: Download PDF or Fill Out Online

12. Iontophoresis Consent: Download PDF or Fill Out Online

13. Monitored Sedation Consent: Download PDF or Fill Out Online

14. IV Vitamin C Consent: Download PDF or Fill Out Online

15. Modalities Consent: Download PDF or Fill Out Online

16. Nightlase Consent: Download PDF or Fill Out Online

17. NTI Informed Consent: Download PDF or Fill Out Online

18. Oxygen/Ozone Therapy Consent: Download PDF or Fill Out Online

19. Restorative Dentistry Consent: Download PDF or Fill Out Online

20. Sinus Lift Consent: Download PDF or Fill Out Online

21. Surgical Treatment and Care Consent: Download PDF or Fill Out Online

Post Operative Instructions

1. Post Pinhole Gum Lift: Download PDF or Fill Out Online

2. Post Injection Guidelines: Download PDF

3. Post Surgical Treatment: Download PDF

Schedule Your Appointment with the Holistic Dentist

Every service we offer is aimed at improving your overall health. We offer several procedures that eliminate the need for surgical incisions, reducing your discomfort, downtime, and the need for multiple visits. Call our office to schedule your consultation today.