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If you are a new patient to our office, the attached 6 files contain our new patient forms that will need to be filled out prior to your New Patient office visit.
You can type them online or print them out and fill them out by hand. Printing and bringing the completed forms with you will allow Dr. Itzkowitz to go over your medical and dental history and allow us to attend to your dental needs more quickly than completing them on your arrival. Thank you and please call our office if you have any questions at all.
New Patient Forms
Please complete 1 through 6
1. WELCOME_TO_OUR_PRACTICE FORM.pdf *Bring in 3 completed pages.
2. HIPAA Omnibus 2014 REV.docx (Keep this for your records).
3. New HIPAA Acknowledgment_Form.doc *Bring signed copy to office.
4. FINANCIAL POLICY *Bring signed copy to office.
5. Revised Patient consent for e-mails work up.docx (Keep for your records).
6. ELECTRONIC MAIL ACKNOWLEDGEMENT FORM *Bring to office for signature. We only use email to send correspondence to patients or confirm appointments at their request.
Surgical POST OP Form
POST OP INSTRUCTIONS