Patient Forms

(518) 477-2727

Now you can complete the necessary information at your leisure. The Patient Registration/ Health History Form is an electronic form that you can submit at the end. 

--Patient Registration/ Health History Form  

Click to print the forms below.

--Electronic Funds Transfer Form

--Dental/Orthodontic Insurance Information Form

--Insurance Reimbursement Tracking Form

-- HIPPA Notice of Privacy Practices 

--HIPPA Notice of Privacy Practices Acknowledgement

If you need help filling out the forms, just call us or let us know when you arrive for your appointment.


 This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

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We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.