Forms

In order to comply with new guidelines and to continue to be technologically advanced, we are becoming a “paperless” office, transitioning to all electronic health records. At your next visit, you will be asked to sign an Informed Consent form, your Health History, and our Acknowledgement of Receipt of Notice of Privacy Practices (HIPAA).

Please bring a list of your medications and any other pertinent information regarding your past medical history, allergies, and Primary Care Physician’s information. We thank you for your continued trust in helping us provide you with excellent care.

Yours in health,

The Team at Holly Tree Dental

 

Please note: There is no need for you to fill these forms out and bring them with you.  Please simply familiarize yourself with them, and be prepared to sign them during your visit with our team.

 

• Health History
• Informed Consent
• Acknowledgement of Receipt of Notice of Privacy Practices

 

Here is a copy of our office’s Notice of Privacy Practices:

Notice of Privacy Practices