Thank you for choosing Gordon Dentistry. We strive to provide you with the best possible dental care. The following dental patient forms are designed to help us meet all your healthcare needs. Please fill out the appropriate dental patient forms completely. If you have any questions or need assistance, please ask us — we will be happy to help.
Please complete the medical information and dental patient forms on your computer, then print and bring with you to our office.
Click on the links below to access the printable dental patient forms:
Patient First Visit
Your first visit to Gordon Dentistry establishes a vital foundation for our relationship. You can save some time at your first visit by completing and printing out the dental patient forms in advance of your appointment.
During your first visit, we will review your medical history and document any medications or herbal supplements you may be taking so that we are aware of any conditions that may impact your oral health. To understand what to expect for your first visit to our practice, please read through this page.
If you already have an appointment and would like to save time at your first appointment by completing your dental patient forms ahead of time.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Click here to – Download the New Patient Form
Total Joint Replacement Form
The American Heart Association updated their recommendations for antibiotic prophylaxis to prevent infective endocarditis in April 2007. The following conditions warrant antibiotic prophylaxis: prosthetic cardiac valves, history of previous infective endocarditis, severe or unrepaired congenital heart disease, completely repaired congenital heart defect with prosthetic material or device during the first six months after the procedure, repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device, cardiac transplantation recipients who develop cardiac valvulopathy. Patients with a history of heart attack or stents or bypass surgery generally do not require antibiotic prophylaxis. Click here to – Download the Total Joint Replacement Form
Mutual Agreement Form
This serves as an agreement between our office and you regarding our policies on treatment planning, appointment times and payment policies. Click here to – Download the Mutual Agreement Form
Notice of Privacy Practices
HIPPAA. The Health Insurance Portability and Accountability Act of 1996 (HIPAA; Pub.L. 104–191, 110 Stat. 1936, enacted August 21, 1996) was enacted by the United States Congress and signed by President Bill Clinton in 1996. Click here to – Download the Notice of Privacy Practices
Patients Using Insurance Benefits Form
This notice describes what you can expect from your insurance benefits. We will complete this form based upon the insurance information you provided to us. After we scan your signature, we will return this form to you for your reference. It is not necessary to print this form and bring it with you. Click here to – Download the Patients Using Insurance Benefits Form
You can save some time at your first visit by completing and printing out the dental patient forms in advance of your appointment.