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Patient Forms

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

New Patient Information

Health History Form

HIPPA Form

New Patient Records Release Form 

The form below is for Dr. Krumholz's existing patients who wish to give authorization to release X-Rays to another dental office. 

Records Release Form

 

 This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.