Click on buttons to the left to open the appropriate form in a new tab.
Acknowledgement of Privacy Rights
Notice of Privacy Practices
Consent to Use Records
You can then save and download the file to your computer.
If you are able, please print the form, fill it out, and send it to us before your appointment to ensure that there is as little waiting time as possible when you arrive for your appointment.
|"Providing evidence-based preventive, restorative and cosmetic dental care for all ages."|
Contact Us | Smile Gallery | Dental Services | For Patients | Our Office | About Us | Home | Evidence-Based Dentistry | Meet Dr. Wentworth | Meet the Staff | Your First Visit | New Patient Forms | Payment & Insurance | Schedule an Appointment | Dental Implants | Cosmetic Dentistry | Preventive Dentistry | Restorative Dentistry | Periodontal Treatment | Our Technology | Tour the Office | Connect on Facebook