First Visit

New Patient Forms

Or you may download and print the forms below

On your first visit to Dresher Dental please bring with you the following completed and

signed forms and information. Please just click on the form to download.

HEALTH HISTORY FORM (2 sides)

Health History Form (page 1) Health History Form (page 2)

A SIGNED CONSENT FOR TREATMENT FORM

A SIGNED ACKNOWLEDGEMENT OF RECEIPT OF NOTICES OF PRIVACY PRACTICES

(once you have read our notice of privacy practices)

Notice of Privacy Practices (page 1) Notice of Privacy Practices (page 2)

A COPY OF YOUR INSURANCE CARD AND ANY OTHER INSURANCE INFORMATION YOU MAY HAVE, INCLUDING THE SOCIAL SECURITY NUMBER AND BIRTHDAY OF THE SUBSCRIBER TO THE INSURANCE.

PLEASE CONTACT YOUR PREVIOUS DENTAL OFFICE TO HAVE ANY CURRENT X RAYS AND DENTAL RECORDS FORWARDED TO US. THIS INFORMATION CAN BE E MAILED TO DresherDental@gmail.com OR HAVE THEM FORWARD IT TO US VIA REGULAR MAIL AT OUR OFFICE ADDRESS LISTED BELOW.

First Visit

New Patient Forms

On your first visit to Dresher Dental please bring with you the following completed and

signed forms and information. Please just click on the form to download.

HEALTH HISTORY FORM (2 sides)

A SIGNED CONSENT FOR TREATMENT FORM

A SIGNED ACKNOWLEDGEMENT OF RECEIPT OF NOTICES OF PRIVACY PRACTICES

(once you have read our notice of privacy practices)

A COPY OF YOUR INSURANCE CARD AND ANY OTHER INSURANCE INFORMATION YOU MAY HAVE, INCLUDING THE SOCIAL SECURITY NUMBER AND BIRTHDAY OF THE SUBSCRIBER TO THE INSURANCE.

Please advise your previous office to send the x rays in a jpeg format or Dexis format if available.

PLEASE ALSO REVIEW OUR MISSED OR CANCELLED APPOINTMENT POLICY

PLEASE FEEL FREE TO CONTACT US WITH ANY QUESTIONS PRIOR TO YOUR FIRST VISIT.

WE LOOK FORWARD TO MEETING YOU AND BEING A

PARTNER IN YOUR DENTAL HEALTH CARE.