Diplomate, American Board of Pediatric Dentistry 817-292-5140 817.292.5140Email Us email us

First Visit

your first visit

focused dentistry for infants, children & teens

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Children crawling, walking, skipping, jumping

 

 

welcome

Before your first visit you may access the following forms to assist us with your care.
Please download, print or fill out all the following forms below and bring them to your next appointment.
You will need to read the Notice of Privacy Practices form and print and sign the form of Acknowledgement and the form of access.
The Notice of Privacy Practices, presents the information that the federal law requires us to give or patients regarding our privacy practices.

 

 

 

new patient forms

PLEASE DOWNLOAD AND COMPLETE ALL FORMS

Patient Account Information
Patient Health History
Consent for Treatment
Financial Policy

Patient Guidelines

Insurance Information
HIPPA Health Access Form
acknowledge receipt of privacy notice
HIPPA Privacy

CONTACT INFO

FORT WORTH

6210 John Ryan Drive
Suite 100
Fort Worth, Texas 76132

817-292-5140

Our current office hours are:

Mon, Tues, Thurs: 8:30 a.m. - 4:00 p.m.
Wed, Fri: 8:00 a.m. - 12:00 p.m.