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