New Patients

Forms

Now you may Download and Print your dental forms at your own home and bring them into the dental office before your first visit! It's convenient, it's less stressful, and it's easy!

To download a form, simply click on the name of the form you wish to download.

Note: Forms are in Adobe PDF format and you will need an Adobe PDF Reader to view and print them.

Patient Registration
Notice of Privacy
X-Ray Release Authorization
Request for X-Ray Release
Authorization to Release Info
Treatment Consent (under age 18)
Third Party Liability
Third Party Parental Liability
Call us today for an appointment
at our 2 Evansville locations!

812-425-4206 (North)      812-473-1900 (East)
Tri State Family Dental Centers
800 First Ave, Evansville, IN 47710    |    (812) 425-4206
960 S. Hebron Ave, Evansville, IN 47714    |    (812) 473-1900

TriState Family Dental Centers    |    800 First Ave, Evansville, IN 47710     (812) 425-4206    |    960 S. Hebron Ave, Evansville, IN 47714     (812) 473-1900


Website created by Infostar Dental Websites.     Copyright © 2010 Infostarproductions.com

Infostar Dental DVD Showcase   |   Dental Patient Education Sidekick Program   |   Infostar Dental Websites   |   Dentist Network Online