Patient Forms
Save time at your appointment by completing your paperwork in advance. Download and fill out the appropriate forms before your visit.
Download Your Forms
To provide you with the best possible care, we need to know about your medical history, current medications, and dental concerns. Please complete these forms before your appointment to help us streamline your visit and ensure we address all your needs.
New Patient Forms
Notice of Nondiscrimination
Outlines Bright Smile Dentistry’s non-discrimination policy and available accessibility services.
Notice of Nondiscrimination Part 2
Outlines Bright Smile Dentistry’s non-discrimination policy and available accessibility services.
Notice of Nondiscrimination Part 3
Outlines Bright Smile Dentistry’s non-discrimination policy and available accessibility services.
Medical History
Complete health questionnaire to help us understand your overall health and any conditions that might affect your dental treatment.
Insurance & Financial Forms
Financial Policy
Our office financial policies and payment options. Please review and sign this form.
Acknowledgement of Receipt of Notice of Privacy Practices
Confirmation that the recipient received and reviewed the Notice of Privacy Practices.
Notice of Privacy Practices – Page 1
Explains how personal health information is collected, used, and safeguarded by the provider.
Notice of Privacy Practices – Page 2
Details patients’ rights and how medical information may be used or disclosed.
Privacy & Security
At Bright Smile Dentistry, we take your privacy seriously. All information you provide is kept confidential and secure in accordance with HIPAA regulations.
If you prefer not to fill out these forms electronically, you may print them and bring them to your appointment, or arrive 15 minutes early to complete them in our office.