I Am Ready To See a Pediatric Dentist Near Me!

Please click on one of the following forms below and kindly fill it out prior to your child’s dental office visit. These forms will allow us to get to know your child’s current state of health, provide important information that we need for their records, and grant us permission to provide them with an excellent dental service.

Save Time

All of our forms can easily be filled out on your computer using Adobe PDF. If you do not have Adobe Acrobat, please make sure to download a copy here. We know that children do not always behave as expected, and rather than spending time filling out forms upon arrival at our office, we find that by you being able to cater to your little ones as they maneuver the play area and meet other children leads to a more positive experience.

After you download and fill out the forms simply print them out and bring them into the office or you can request to email/fax them over.


New Patient Form


Treatment Consent Form


Behavior Management Consent Form


General Consent Form


Anesthesia Consent Form

Which Forms Do I Need?

It can be a bit daunting at first trying to figure out which forms are needed for a Pediatric dentist near me. Not to worry, If this will be your child’s first visit and they only need a cleaning all but the last form will be needed (New Patient Form, Treatment Consent Form, Behavior Management Consent Form, General Consent Form).

If your kids will require a dental procedure that involves extraction, or any other type of service where it is beneficial for the patient to have anesthesia administered, the last form, “Anesthesia Consent Form” will be needed as well. Your child’s safety is always our first priority, thus only when needed, will the professional application of anesthesia be utilized.

We look forward to helping your little one have a pleasant dentistry experience! Should you have any questions or concerns, please visit our contact page or subscribe to our blog where you can learn more about our services and dedication to your children’s dental health.

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