Patient Forms

Download and complete the forms as requested.

Patient Forms

Patient Welcome Letter

Health History & Medical Information

Patient COVID Screening Questionnaire

Patient PHI Authorization of Care

Patient Authorization to Disclose Protected Health Information (PHI) Form

Notices

HIPAA Notice of Privacy Practice

Implant Dentistry & Perio Rehab

Call Us

Our Location

2106 Virginia Dr. Ste A, Wichita Falls TX 76309

Contact Us

11 + 12 =