New patients - please download the following 4 forms to us so that we may schedule you an appointment:

1. Patient information form:
   New Patient form - Authorization For Release of Dental Records. If you prefer, you can fax your completed forms to (928) 855-8605.
2. Medical information form:
   New Patient Registration form - Print and fill out form - return to office on first visit. This form includes information on your Health history, medications, allergies and Dental History.
   New Patient Registration - in Spanish
3. Hippa form:
   Health Insurance Portability and Accountability Act form (HIPPA) and Notice of Privacy Practices and describes how medical information about you may be used and disclosed.
4. Office policy form:
   Our Office Policy - Print and sign the bottom.

Fax the completed forms to us at 928-855-8605  In addition if you need financial assistance with your bill then download the Care Credit application and fax it back to us.