Get the paperwork done
before you arrive.

What forms are involved

• Patient Registration. Basic contact and household information.
• Health History. Current and past medical conditions, medications, allergies, and important considerations for your dental care.
• Dental History. Past dental treatment, concerns, goals, and any anxiety considerations.
• Insurance Authorization. Lets us file claims on your behalf.
• HIPAA / Privacy Acknowledgment. Confirms how we protect your health information.
• Financial Policy. Outlines payment expectations and options.

How to complete them

When you book your first visit, our office will email a secure link so you can complete forms on your phone, tablet, or computer. It takes about 10 minutes. Everything is encrypted and goes directly to your patient record.

If you’d rather fill out forms by hand, give us a call at 540-418-0825 and we’ll mail or email PDFs you can print.

Why your health history matters

Conditions like diabetes, high blood pressure, heart valve replacements, or recent surgeries can affect dental care. Certain medications change bleeding risk or the way we numb teeth. The more we know up front, the safer and more comfortable your visit will be. If you’re not sure whether something is relevant, mention it anyway.

For minors

A parent or legal guardian must sign forms on behalf of any patient under 18. Plan to be present at the first visit so we can review the health history and answer any questions together.

If you’ve been our patient before

You don’t need to complete the full registration packet again — just an updated health history. Things change: a new medication, a new diagnosis, a change of address. A quick update keeps your record accurate.

Questions about a form

Don’t guess. Call us at 540-418-0825 and we’ll walk you through any question that doesn’t seem clear.