New Patient Forms

To create a chart at the offices of Dr. Mark Freeman & Associates, information is required from the patient.  Listed below are the forms needed for new patients or if you have not visited our office for over three years.  This information will alert our Doctors and Hygienist of any medical issues which involve your dental care.  If you have an extensive list of medications, please bring a copy to your appointment.  The personal information collected will establish your contact numbers and aid our Office Staff with insurance filing and billing.  To help make your first visit go quickly and smoothly, please download the forms below, fill them out in advance and bring them to your appointment.  If you are unable to download, the forms will be available at our front desk at the time of your appointment, or we will be happy to mail them to you.   A set of forms will need to be completed and signed for each family member.

In order to view or print these forms you will need Adobe Acrobat Reader installed.
Click here to download it.

Up-Date Forms

In accordance with HIPAA guidelines, your patient information and medical history must be up-dated once a year.  If you have an extensive list of medications, please bring a copy to your appointment.  To help lessen paperwork, our Office Staff rotates which forms need to be up-dated each visit.  We understand that there may not have been any changes and appreciate your cooperation with obtaining this information.  To help make your visit go quickly and smoothly, please download the forms below, fill them out in advance and bring them to your appointment.  If you are unable to download, the forms will be available at our Front Desk at the time of your visit.   The information will need to be up-dated and signed for each family member.

 

Additional Information

Below is a list of additional information available through our office.  Please feel free to download the material for your personal use or to share them with someone you know who may have a specific need.

 

 

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