Patient Forms
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.
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
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.
