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


Your Patient Rights (Notice of Privacy Practice)

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Implant Dentistry & Perio Rehab

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Our Location

2106 Virginia Dr. Ste A, Wichita Falls TX 76309

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