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If
you would like to complete your registration form before you arrive, you
may download it by clicking below. The
new patient form is in PDF format. If
you do not have Acrobat Reader, get a free copy by clicking on the link
below. Also, after
reading the Notice of Privacy Practices, print
the Acknowledgement form below, sign it, and bring it in, too.
New
Patient Form (Acrobat PDF form)
Acknowledgement
of Receipt of Notice of Privacy Practices (web page)
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© Copyright 2002- Dental
WebSmith, Inc. and Richard E. Patelski, DDS. All rights reserved.
Disclaimer: The information provided within
is intended to help you better understand
dental conditions and procedures. It is not meant to serve as delivery of medical
or dental
care. If you have specific questions or concerns, contact your health care provider.
