Patient Forms
For your convenience, please download the PDF fillable forms and save, fill all applicable sections and then email to info@greatlakesdental.net with your name in subject line. On an average it will take at least 15-20 minutes to fill these forms at the office. Please plan on arriving accordingly to your first appointment.
Please update us if there are any changes to your health status, insurance and/or contact information.
Para su comodidad, descargue los formularios que se pueden completar en PDF y guárdelos, complete todas las secciones correspondientes y luego envíe un correo electrónico a info@greatlakesdental.net con su nombre en el asunto. En promedio, tomará al menos 15-20 minutos completar estos formularios en la oficina. Planee llegar en consecuencia a su primera cita.
Actualícenos si hay algún cambio en su estado de salud, seguro o información de contacto.
New Patient Forms
Existing Patient Forms
Recall History
English and Spanish
Consent for Treatment
English – Page 1; Spanish – Page 2
Dental Implant Consent
English
Dental Implant Consent
Spanish
For Information Purposes
Office & Financial Policy
English – Page 1; Spanish – Page 2
Patient Care Instructions
English – Page 1; Spanish – Page 2
HIPAA Notice of Privacy Practice
English
HIPAA Notice of Privacy Practice
Spanish
What to expect at your first visit:
— Verification of personal information, health history and benefit plan / insurance coverage
— Exam, X-rays, pictures, consultation and simple teeth cleaning (if applicable)
— Topical fluoride (Kids), oral hygiene instructions and patient samples
— Discuss treatment plan and insurance breakdown for payments
— Follow-up treatment / recall visit appointment