Online Dental Forms

Below are electronic versions of the medical, consent and privacy forms used at Hitchcock Dental. We offer these for two major reasons. First, we offer them to improve records accuracy – your responses are typed, instead of hand-written. And second, we offer them to reduce the time spent “in the office.” You will now be able to fill out these forms, and print them from your home computer – at your convenience. This way you won’t have to arrive “15 minutes early” to update your records.

Our forms require the use of the Adobe Acrobat Reader. If you do not have this version, please download it at http://www.adobe.com/ .

Hitchcock Dental Privacy Practices

This form outlines the Privacy Practices at Hitchcock Dental.  This document outlines your privacy rights, and explains how Hitchcock Dental works to protect and secure your dental records.

Patient Health & Dental History

Understanding a patient’s medical and dental history is crucial in providing effective ongoing dental care. This form provides the opportunity to document your medical and dental history.

Patient Insurance & Contact Info (Adult)

This form is used to provide your contact information, insurance information and emergency contact information. This form is for our adult patients.

Patient Insurance & Contact Info (Child)

This form is used to provide contact information, insurance information and emergency contact information for our pediatric patients. This form should be completed by the responsible party.

Please open each form, in your browser by clicking the form icon on the left.  That should open the form in Acrobat Reader so you can fill in the form using your computer. Once completed, please print your form. Using the print button at the bottom of the form or the print function from the menus in Acrobat Reader.   Please then sign the form in the indicated spaces, and bring the form with you on the day of your appointment.  You may also drop the forms by the office at any time prior to your appointment if convenient.

ADA Informed Consent Guidelines

This document provides general information about each type of treatment or procedure offered by Hitchcock Dental. It provides information about the expected outcomes and potential risks of each procedure. This is a standardized document provided by the American Dental Association.

ADA_Consent_Form HD_Privacy_Practices Patient Health & Dental History Personal Info Adult Personal_Info_Child

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