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Patient Information
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New Patient Forms
NEW PATIENT
Demographic Form
(Adult)
New patient form that needs to be completed prior to service/s for adults.
NEW PATIENT
Financial Policy
The Financial Policy details of basic policy, fees, and any other financial acknowledgements for our patients.
NEW PATIENT
Health History
The Health History form is designed to determine any potential risk to our patients before any procedures are done. This would include allergies, medication taken, heart conditions, and any other possible conditions that may of concern to the office staff.
NEW PATIENT
HIPAA
The HIPAA privacy notification document is designed to inform our patients of their rights to privacy and to ensure you that we take every measure to uphold and protect your personal information.
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Other Forms
NEW PATIENT
Health Care
Release Form
The Authorization to Release Health Care Information form is an acknowledgement and agreement to release health care information in care of Randall J Russell DDS.
NEW PATIENT
No Show /
Cancellation Policy
Information on how the no-show cancellation policies work.