WE LOOK FORWARD TO MEETING YOU!!
In order to expedite the new patient registration process, please bring the following 3 forms completed with you to your first visit.
1) Patient Registration Form. This form provides us general information about how we may contact you, your dental insurance, and your emergency contact information.
2) Please review Gum Disease Specialists Notice of Privacy Practices and sign the Acknowledgement of Privacy Practices (HIPAA) Form.
3) Health History Form. In order to provide you with the best possible services, we need to know
more about your medical history. Many periodontal conditions and the results of our therapies are influenced by your systemic health.
alt) Pediatric Health History. If your child is under the age of 19, please use this health history form.
You may also scan and email the forms to us: firstname.lastname@example.org
Fax them to our office at 402.493.4746
*If you should have any questions, please call us at 402-493-9429
Post-Surgical Instructions. This form answers commonly asked questions about how to care for your surgical site. It also informs you about what to expect after surgery.