New Patient Forms

We are happy to offer our patient forms online. Please feel free to print and fill them out at your convenience before your visit.

 

New Patient Registration

Please download, print and complete this form before your first dental appointment.
Click here to download (66 KB)
 

Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information.
Click here to download (295 KB)
 

HIPAA Form

Please download, print and complete this form before your first dental appointment. This form confirms that you read our Notice of Privacy Practices.
Click here to download (229 KB)
 

 
If you are unable to view the pdf files, please click on the icon below to download and install Adobe Reader:

5415 S Cooper St Ste 127
Arlington, TX 76017
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Phone: (817) 466-1131

Office Hours*:
Mon9:00am-6:00pm
Tues9:00am-6:00pm
Wed9:00am-6:00pm
Thur9:00am-6:00pm
Fri9:00am-6:00pm

* Emergency patients can be seen the same day. We are an in network provider for many PPO insurance, Medicaid and CHIP