Patient forms

Coming for an appointment?  We are excited and honored you chose our practice!

To make your first visit easier, below are forms that you will be asked to complete prior to your arrival. If possible, please complete all of the information below and bring it along with you.

If you need assistance completing any of these forms, don't hesitate to call us at (716) 828-9334.

• Patient registration (Also available in Arabic & Spanish)
• Medical history (Also available in Arabic & Spanish)
• Consent to use and disclose protected health information for treatment, payment and health care operations (Also available in Arabic & Spanish)
• Consent for dental treatment and anesthesia (Also available in Arabic & Spanish)
• What to Expect after a Root Canal
• What to Expect after a Tooth Extraction
• What to Expect after Scaling and Root Planning
• What to Expect with New Dentures
• Dental Periodontal Disease
• Dental What is Scaling and Root Planing
• Dental Nightguard - Patient Education
• Dental Treatment During Pregnancy - Patient Education
• Dental Treatment with Radiation Treatment- Patient Education
• Dental Blood Thinners and Dental Treatment - Patient Education
• Dental Patients who need Medical Clearance
• Dental HIPAA Privacy Rules for the Protection of Health and Mental Health Information
• Patient Bill of Rights (Also available in Spanish)
• NYS Healthcare Proxy and NYS Advanced Directives

Have questions?  We are here to help!  Call (716) 828-9334 or email us