The University of Iowa College of Dentistry

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 (English version) (.pdf)
• Patient Registration Form (Spanish version) (.pdf)
• Pediatric Health History Form (English version) (.pdf)
• Pediatric Health History Form (Spanish version) (.pdf)

Other Important Forms

• Consent to Release Health Information (.pdf)
• Central Records Fax Cover Sheet (.pdf)

Referral Form

• Referral to Pediatric Dentistry (.pdf)

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