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The New Patient form is in PDF format, which can be read using Adobe Acrobat Reader. If you do not have Adobe Acrobat Reader, get a free copy by clicking on the link below.

Adobe Reader

When you have Acrobat Reader, click on the link below to download the New Patient form. (If you are on a dial-up modem connection, please be patient - it may take a few minutes).

Adobe PDFMedical History Form

Adobe PDFPatient Interest Form

Adobe PDFFinancial Policy

The Pre-Authorization form is a web page that can be printed from your browser:

Pre-Authorization Health Care Form (web page)

Also, please review our Notice of Privacy Practices and then print the Acknowledgement form:

Acknowledgement of Privacy Practices (web page)

Print the forms, fill them out, and bring them with you on your first visit.

 


Home | Meet the Staff | Office News | Office Tour | Conditions | Procedures
Advice for Parents | Payment / Insurance | New Patient Forms | Referring Doctors
Map and Hours | Contact Us | Ask the Doctor | Request Brochure | Kids' Zone

© Copyright 2003- Dental WebSmith, Inc. and Paul A Weiss, DDS. All rights reserved. Disclaimer: The information provided within is intended to help you better understand dental conditions and procedures. It is not meant to serve as delivery of medical or dental care. If you have specific questions or concerns, contact your health care provider.

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