Why Pediatric Dental Forms and Instruction Sheets

Children’s Dental Health Reception Desk

Online Forms

New Patient Form
Submit Online or
Download (PDF)

Medical History (PDF)

Consent for Dental Treatment (PDF)

Consent for Fluoride Treatment (PDF)

Dental Insurance Guidelines (PDF)

Financial/Insurance/Appointment Agreement (PDF)

Consent for Use and Disclosure of Health Information (PDF)

Permission (PDF)

 

“After Treatment” Instruction Sheet

HIPPA Privacy Form (PDF)

Acknowledgement of Receipt of Notice of Privacy Practices (PDF)

 

Children's Dental Health Associates

5 office locations

For an evaluation of your child's teeth, give Children's Dental Health Associates, P.C. a call today at one of our 8 dental office locations serving western Philadelphia, PA suburbs of Drexel Hill, Newtown Square, Lansdowne, Media, Chadds Ford, Kennett Square, Jennersville/West Grove, Pennsbury, West Chester, Downingtown/Thorndale, Lancaster, and Aston PA.

In anticipation of an appointment, you can obtain new patient and medical history forms online.