Dr. Nick's White & Healthy
Patient Forms & Consent
Please review and sign the following documents prior to your appointment.
01
Medical History
Form
This form collects your medical history to ensure your dentist understands any potential interactions between your health and your dental treatment.
02
Informed Consent to General Treatment
Consent
This Informed Consent form ensures you understand the proposed dental procedures, potential benefits, risks, and alternatives before making a decision.
03
Financial Agreement
Consent
This agreement outlines your payment responsibilities, including fees, insurance coverage, billing procedures, and consequences of non-payment.
04
HIPAA Form
Form
This form explains your rights under HIPAA (the Health Insurance Portability and Accountability Act) regarding the privacy of your health information.
05
Insurance Information
Form
This form collects your insurance information, so that we may better assist you and maximize your insurance benefit.