Patient Forms
Forms for New Patients
Please fill out these forms at home. Be sure to bring them with you to your next appointment or submit through e-mail.
- Patient Registration Form
This form is for patients registering for the first time at our practice. Info includes your name, address, insurance details, etc.
- Medical History Questionnaire
Providing info such as prescribed and non-prescribed medications will help us provide the safest dental care for you.
- X-Ray & Patient Chart Release Form
This release form will let us request access to your patient records from your previous dentist.
Physician Examination Pre-Anaesthetic Form
If requested by Dr. Midroni, the Physician Examination Pre-Anaesthetic Form will need to be completed by your family physician prior to your sedation appointment.
- Physician Examination Pre-Anaesthetic Form
Print this form in the comfort of your home, and bring to your Physician/MD to fill out.