Why Pediatric Dental Forms and Instruction Sheets

Children’s Dental Health Reception Desk

Online Forms

New patients need to:

  • print out all 10 forms (if you are able)
  • then fill in the information, and
  • bring the forms with your to your child's appointment.

New Patient Form - 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)

HIPPA Privacy Form (PDF)

Acknowledgement of Receipt of Notice of Privacy Practices (PDF)

 

“After Treatment” Instruction Sheet

 

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, Harrisburg and Aston PA.

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