Patient Forms

For your convenience, we have created these new patient forms in an editable .PDF file format.  This allows you to fill out the form, print it out, and bring along with you to your appointment.  You will need Adobe Reader installed in order to use the forms. These forms are available on the Patient Portal. Please use the Patient Portal button located on the bottom of this page to access these forms.


New Patient Form

We ask that all new patients fill out this New Patient Form Packet.  It includes your information, medical and dental history, and the HIPAA Consent Form.  This packet is available on the Patient Portal.


Health History Form

The Health History Form is available on the Patient Portal.


HIPAA Consent Form

This form is to obtain an individual’s written permission under Wisconsin law for (a) our use of the individual’s dental care records to carry out treatment, payment activities, and health care operations, and (b) our disclosure of the individual’s dental care records to carry out treatment, payment activities, and health care operations.

The HIPAA Consent Form is available on the Patient Portal.

Patient Portal