New Patient Form You can save time in our office filling out the following forms at home and bringing them with you to your first appointment. Financial Policy Medical History Notice of Privacy Practices Patient Name * (Last, First) Address, City, Zip Code * Phone Number (home) Phone Number (cell) Phone Number (work) Email Address * (The person responsible for the account.) Parent/Guardian Name How did you find out about our office? (Phone book, Internet, Friend, etc) What is the name of your previous dentist? Do you require pre-medication prior to a dental visit? Please list additional family members and birthdates if you are scheduling more than one appointment.