Forms English

Please print and complete forms before your appointment and bring to the appointment.

New patient packet includes:
Medical and Personal History
Guardian Agreement
Consent for Endodontic Treatment
Nitrous Oxide/Oxygen Inhalation Sedation Patient Consent Form
HIPPA Privacy Act

Click to Download ALL Forms as a Single File

Additional information for patients:

• What to do after Root Canal Treatment
• Facts you should know about dental insurance
• Listing of insurance plans accepted at Root Canal Dentists
• Before and After Instruction for Patients (Adult) Receiving Oral Sedation
• Before and After Instruction for Children Receiving Oral Sedation

All minor patients (under the age of 18) must be accompanied by a parent or legal guardian for all appointments and must remain with the patient until treatment is completed.

Be sure to bring your proper photo ID and Medicaid/CHIP/insurance card.