• (701) 280-1941
  • Mon - Thur: 8:00am - 5:00pm
  • 3210 18th Street South Suite A Fargo, North Dakota 58104
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  • Our Team
    • Meet Dr. Susan Althoff
    • Meet Dr. Lichtsinn
    • Meet the Staff
    • Tour Our Office
    • Continuing Education
  • Smile Gallery
  • Patient Information
    • Patient Information
    • Existing Patients – Portal
    • New Patient Forms
    • Map and Directions
    • Need More Information?
  • Dental Services
    • Family Dentistry
    • Implant Restorations
    • Cosmetic Dentistry
    • TMJ
    • Dental Technology
    • Sleep Apnea / Snore Guards
  • Contact Us
Menu
  • Our Team
    • Meet Dr. Susan Althoff
    • Meet Dr. Lichtsinn
    • Meet the Staff
    • Tour Our Office
    • Continuing Education
  • Smile Gallery
  • Patient Information
    • Patient Information
    • Existing Patients – Portal
    • New Patient Forms
    • Map and Directions
    • Need More Information?
  • Dental Services
    • Family Dentistry
    • Implant Restorations
    • Cosmetic Dentistry
    • TMJ
    • Dental Technology
    • Sleep Apnea / Snore Guards
  • Contact Us

New Patient Forms

Please print, fill out, and bring appropriate forms to your first appointment:

For complete exam:

Registration
Dental Questionnaire
Confidential Health History
Southpointe Dental Financial Policy
HIPAA Signature Document

For emergency evaluation:

Emergency Registration & History
Southpointe Dental Financial Policy
HIPAA Signature Document

For a child exam:

Child Information
Southpointe Dental Financial Policy
HIPAA Signature Document

Please read prior to your appointment:

HIPAA Privacy Notice

Other forms:

Authorization for dentist to release records to Southpointe Dental
Authorization for Southpointe Dental to release records to another office

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