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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
Demographic Form
(Under 18)
New patient form that needs to be completed prior to service/s for anyone under the age of 18.
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
Financial Policy
The Financial Policy details of basic policy, fees, and any other financial acknowledgements for our patients.
NEW PATIENT
HIIPA
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.
NEW PATIENT
Sedation Information
The Sedation Information Form details of basic information about the risks of an operation for our patients.
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Pre/Post Operative Care
PRE OPERATIVE CARE
Recommended Pre-Purchase Grocery List
We have a list of recommended inexpensive items that can be purchased to assist with the healing process.
PRE OPERATIVE CARE
Pre-Anesthesia
Instructions
The following document includes general instruction of Anesthesia, requirements, and any other recommendations before a procedure
POST OPERATIVE CARE
Post-Operative
Instructions
This document outlines steps that you should take after surgery for proper care and expedite healing.
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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.