Attleboro Periodontics & Implantology
Sheldon J. Itzkowitz, DDS,FICD
Creating and Maintaining Healthy Smiles

Patient Forms

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 June 21.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


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Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.