Forms
Patient Forms
Please do not fill out Patient Forms without a
scheduled appointment. Thank you!
Patient Forms
-
Health Questionnaire
Please fill this form out 24 hours prior to your child's scheduled appointment.
-
Consent for Treatment of a Minor
Parent/Legal Guardian to fill this form out when they will NOT be present to accompany their child(ren) to their dental appointment.
-
Consent to Discuss Health Information
Parent/Legal Guardian to fill this form out and list any parties who may have access to their child(ren)’s dental records.
-
Silver Diamine Fluoride Consent
3402 Washington Rd, McMurray, PA 15317