Patient Forms West

The lost toothFor our New Patient Families, please click on the first link below to complete your family forms. If you are a Current Patient Family and have a Recare appointment scheduled with us, please click on the appropriate link to complete your child’s Medical Health History Update and Parent Guidelines Update. When you click SUBMIT at the end of your forms, they will email directly to our Scheduling Coordinator. If you encounter any problems while filling out your forms, please call us for assistance.

We ask that you complete your patient forms at least one week prior to your appointment, so that we can begin your child’s adventure with the World of Smiles team on time!

Online Forms to Complete

New Patients Start Here

Release Of Records

Alternate Guardian Consent

Special Needs Supplement

Read Only

Health Insurance Portability and Accountability Act

Optional Information

Nitrous Oxide & Conscious Sedation Informational Guide

Release of Records Form (please note, we need a minimum of 4-7 business days notice prior to transferring records)

For Doctors & Other Providers

Refer A Patient

 

Questions? Contact Us for more information.

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Our Doctors

Our Services

  • Education & Prevention
  • Nutrition Counseling
  • Diagnosis and Treatment
  • On-Call Emergency Care
  • In-Office Sedation
  • General Anesthesia

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