Save Time at Your Appointment
Completing your patient forms before your visit allows us to spend more of your appointment time on your care — not paperwork. Please download, print, and complete the appropriate forms below and bring them to your appointment.
If you prefer to complete forms at our office, please arrive 15 minutes early to allow enough time before your scheduled appointment.
Available Forms
New Patient Registration
Complete this form before your first visit. Includes personal information, emergency contact, and dental history.
Medical History Form
A complete medical history helps us provide the safest, most effective care. Please list all medications and health conditions.
HIPAA Privacy Notice & Consent
Review and acknowledge our privacy practices as required by federal law. Includes authorization to use and disclose health information.
Dental Insurance Authorization
Authorizes Italian Smiles to bill your dental insurance directly and receive payment on your behalf.
Financial Policy Agreement
Outlines our payment policies, including payment due at time of service, insurance filing procedures, and financing options.
Periodontal (Gum Disease) Consent
For patients receiving periodontal treatment. Reviews the nature of gum disease, proposed treatment, and alternatives.
Other Ways to Complete Your Forms
By Email
Call us and we'll email your forms directly to you. Complete them digitally and email them back before your appointment.
At Our Office
Prefer paper? Arrive 15 minutes early and our friendly front desk team will provide all necessary forms.
By Fax
We can fax forms to you or accept completed forms by fax. Ask our team for our fax number when you call.
Privacy Notice: Italian Smiles is committed to protecting your personal health information. All patient forms are handled in compliance with HIPAA regulations. Your information will never be shared without your written consent except as required by law.
Need Help With Your Forms?
Our team is happy to assist. Call us and we'll walk you through the paperwork or email forms directly to you.