KENDALIA DENTAL
CENTER
"Expert Care at Reasonable Prices"
Patient Forms

Download, print
and fill out prior to
your visit.
The forms listed are available to download and
print for your convenience.

These forms will need to be completed for all new
patients.
HIPA Consent - Required by Government Regulations (signature
required)
Patient Information - Personal and Insurance Information
Patient Medical History - Patient's Medical and Dental History
Privacy Notice - Privacy Policies of the Kendalia Dental Center
(read only, no signature