Pediatric Dentistry Forms
We want you to feel prepared for your child's visit to Kidsmile. Please print and complete the applicable pediatric dentistry forms and bring to your appointment.
New Patient Forms
Please bring these forms to your first appointment. We also require that you present the dental insurance card, parent/legal guardian’s government-issued photo ID and any custody documentation.
Minor Consent Form
We ask that you use the minor consent form if anyone other than the parent or legal guardian will be bringing the child to the appointment. Parents/legal guardians are required to attend the initial visit.
Dental Release Form
If you'd like your child's dental records to be sent to another practice, please fill out the release form.
HIPAA Notice of Privacy Practices
This HIPAA form explains how our office may use or disclose your child's health records.
We are committed to providing our patients with leading edge dental technologies, and helping your child maintain optimal oral health. Toward these goals, your financial and scheduling responsibilities with Kidsmile, Inc. are outlined in our New Patient Forms.