Patient Health Forms

We know it’s never fun to fill out forms while you’re waiting for your dentist appointment. So, as a new patient, we ask you to complete the Health History and HIPAA forms before your appointment.

Health History Form

Download Health History Form (pdf – 89 kB)

The information provided is important to your dental health. Please make sure you fill out both pages-patient information and dental health history.

 

HIPAA Form

Download Health History Form (pdf – 58 kB)

We are required by applicable federal and state law to maintain the privacy of your health information. The HIPAA form states how we may use and share your health information and how you can exercise your health privacy rights.

Questions about the forms? Don’t hesitate to call.

St. Joseph Dentist Office

If you’re visiting the dentist office in St. Joseph, MI, call 269.983.7888

South Haven, MI Dentist Office

If you’re visiting the dentist office in South Haven, MI, call 269.637.8611