Forms

  • NEW PATIENTS
    New Patient Registration

    Please complete the registration form, electronically sign it and submit the form prior to your appointment. After signing page 2 of this form, you will be directed to our Office Policy and Consent Form for your review and approval. If you have insurance, please bring your insurance card with you to the appointment so we can take a copy to keep on file.

  • NEW PATIENTS
    Office Policy and Consent

    Please review and electronically sign the Office Policy and Consent form and submit it prior to your appointment. This form will give you all of the necessary information regarding appointments, insurance and financial policies in our office.

  • NEW PATIENTS
    Authorization for Release of Dental Records

    If you wish to tranfer your dental records from your former dentist, please review and electronically sign the Authorization for Release of Dental Records prior to your appointment.

  • HIPAA Notice of Privacy Practice

    The HIPAA Privacy Practice form outlines how we protect your privacy in our office. Please review it carefully. Your signature on the Office Policy and Consent form indicates acknowledgement of receipt of the Privacy Practices in our office. If you have any questions, please do not hesitate to contact us.

  • Request an Appointment

    This form will allow you to request an appointment with our office through our patient portal. Please complete the information shown to submit your request. We will contact you as soon as possible to schedule.

  • CareCredit

    Our office is pleased to work with Care Credit to assist patients who are interested in financing their dental treatment. Care Credit offers no interest and low interest loans for health care. Please visit their website for more information, or contact our office if you have any questions.

  • Authorization to Transfer Dental Records

    If you wish to tranfer your dental records from Dr. Stephenson's office to another dentist, please review and electronically sign the Authorization for Transfer Dental Records.