
Mission Statement
Our practice is working together to realize a shared vision of uncompromising excellence in dentistry.
All Smiles Dental Care is committed to:
Patient Forms
Please print and fill out these forms so we can expedite your first visit:
Confidential Patient Information
This form has personal information including name, address, phone numbers, etc.
Dental History
Fill this out to help us know what your past and current dental needs and goals are.
Financial Policy
This policy paper provides information on issues such as insurance, benefits, missed appointments, estimate procedures, and etc. Please review this document if you have any questions regarding our financial polices.
Medical History
All questions that are asked are important to make the dentist aware of conditions and/or medications that may impact your treatment. As with all of your records, this information is kept confidential.
Notice of Information/Privacy Practice
This is not a form to be completed, but is information about how our office maintains your trust by keeping your protected health information private. Explanations of your rights as a patient are included.
Patient Consent/Acknowledgment
This form is used to confirm your understanding of your rights and that you have been offered our Notice of Information/Privacy Practice.
Records Request
To protect your privacy, requests for medical/dental records must be made in writing, and some specific information is required. This form is available for you to use to obtain those records for your personal use or for continuing care.
In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.