New Patient documents

New Patient Documents Download

Welcome to Dental Wellness Centers where we LOVE New Patients!  

  • A few helpful tips to prepare for your initial visit to our practice:
  • Download the New Patient Documents here and complete the forms.
  • Scan/Email or Fax your completed forms to your DWC practice location at least 2 days prior to your appointment if possible.  Also include a copy of your dental insurance card so that our Insurance Coordinator can perform a Complimentary Benefits Assessment for your policy prior to your arrival.
  • Plan to arrive 15 minutes early for your scheduled appointment.  Upon arrival, we will create your New Patient chart and get you acquainted with your new dental home and dental family.  We want to ensure that you have a great dental visit and feel at home at Dental Wellness Centers!

Smile Satisfaction Survey (pdf)

Download

Registration Form (pdf)

Download

Medical History Form (pdf)

Download

HIPPA Privacy Practices Disclosure (pdf)

Download

Financial Agreement, HIPPA Authorization for Disclosure (pdf)

Download

Insurance Claims Acknowledgment Form (pdf)

Download

Patient Records Release Form (pdf)

Download