Patient Forms

We want you to have a positive experience each time you visit our dental office in South Salem, New York. Below, you will find a listing of required forms for both new and returning patients. Click the name of each form to view and then print a copy of it out. Please bring the completed forms in with you on your next office visit. If you have any questions, please feel free to contact our dental team for assistance. We are always happy to help!

Online Patient Form

(All forms are required for new patients. Forms marked with an asterisk (*) are required for returning patients.)

Health History Form

Authorization to Treat a Minor

Responsible Party

Financial Policy

*Notice of Privacy Practices

*Notice of Privacy Practices Acknowledgement

Smile Analysis