Patient Forms
New patients to the College are expected to complete the following forms. For your convenience the following forms can be completed and printed off in advance of your appointment. Please bring these forms with you to your appointment.
- Patient Registration Form (.pdf)
- Registro del Paciente (.pdf)
- Health History Form (.pdf)
- Medications Form (.pdf) **Please bring with health history
- Patient Treatment Consent/Agreement Form (.pdf)
- Student Clinic Care Agreement Form (.pdf)
Other important forms:
If you need your dental records copied, please print off and complete the consent form below, including your signature, and return it to the College of Dentistry.
- Consent to Release Health Information (.pdf) (Copies of Dental Records)
- Authorization for Release of Protected Health Information to a Designated Adult (.pdf)
- Central Records Fax Cover Sheet (.pdf)