- (701) 280-1941
- Mon - Thur: 8:00am - 5:00pm
- 3210 18th Street South Suite A Fargo, North Dakota 58104
New Patient Forms
Please print, fill out, and bring appropriate forms to your first appointment:
For complete exam:
Registration
Dental Questionnaire
Confidential Health History
Sleep Questionnaire
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:
Other forms:
Authorization for dentist to release records to Southpointe Dental
Authorization for Southpointe Dental to release records to another office