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 to register you as a new patient in our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly.  PLEASE HAVE FORMS COMPLETED PRIOR TO ARRIVAL.  Thank you and please call our office if you have any questions at all.  WELCOME TO COUCHMAN CENTER FOR COMPLETE DENTISTRY - WE LOOK FORWARD TO MEETING YOU.

 

WELCOME LETTER

Patient Information Form (Complete form)

HIPPA Patient Form (Complete form)

HIPPA POLICY

FINANCIAL POLICY (Complete form)

Medical History (Complete form)

Smile Evaluation Form (Complete 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.