Patient Forms

Patient Forms

Below are Adobe PDF versions of our common patient related forms. If you are a new patient please make sure to fill out all of the forms below to the best of your abilities prior to your appointment. If you have any questions about the forms or directions on how to fill them out please use the contact us link above or please call us directly at (608) 839-9200. If you are having trouble opening one of our forms please make sure you are using the most recent version of Adobe Reader. To download the newest version please click here. To open the forms below click on any of the thumbnails for each form.

Forms

A Welcome From Blair Family Dental, S.C.

Welcome To Blair Family Dental, S.C. Page 1

Notice of Privacy Practices (HIPAA)

Notice of Privacy Practices Page 1

Patient Rights Acknowledgement Form

Patients Rights Acknowledgement Form

Health History

Health History Page 1