New Patient Forms

If you would like to save time upon arrival, you may print and complete the five forms below and bring them with you when you check in.

MEDICAL & DENTAL HISTORY

PATIENT REGISTRATION

FINANCIAL AGREEMENT

ACKNOWLEDGEMENT OF PRIVACY PRACTICES

PHOTOGRAPHIC RELEASE


Helpful tips to shorten your visit

We encourage you to call ahead to schedule a reserved appointment time. For those who prefer to walk-in, please be prepared to wait, as this is an urgent care facility. Rest assured that our goal is to get you taken care of as quickly as possible, while maintaining the highest quality of care. Ways to decrease your wait time include: call and make a scheduled appointment, use our virtual check-in service, and bring your new patient paper work in pre-completed.

  • The Dental Assistant and Dentist will review your new patient paperwork, medication list, and take your blood pressure

  • Any necessary x-rays and photos will be taken and the Dentist will complete your initial exam

  • The Dentist will explain all of your treatment options and will answer any questions you have

  • The Patient Care Coordinator will review with you all treatment fees and our payment/financing options

  • Payment will be collected and, if you have dental insurance, you will be given a form that you may submit for direct reimbursement

  • Dental treatment will be completed with your comfort as the top-priority, and final photos may be taken


Transfer of Records Back to Your General Dentist

If you have a regular general dentist who you see every 6 months, we will gladly send them any radiographs (x-rays) and treatment notes completed for you at City Dental Urgent Care. If you would like your records transferred, please see our Patient Care Coordinator to sign the record release form.