Patient Forms

Once you have made your child’s first appointment, please click on each of the

below links in order to download and print each form to bring with you to the

office. We look forward to meeting you and your family!

If you have questions regarding or accessing our forms, e-mail us at info@kidsteethRus.com or call our main telephone number (508-337-3307).

 

Medical/Dental History Form (for new patients)

HIPAA Acknowledgement Form

Treatment Consent Form

Behavioral Assessment Form (for special needs children)

**Please complete the Medical History update form below prior to your child's ROUTINE 6 month cleaning visits:
>>>Medical History Update Form


**The COVID-19 form should be completed 24 hours prior to your child's visit. Please call our office with any questions/concerns at 508-337-3307.
>>>COVID-19 Screening Form 

Document with Pen

Save time when visiting our office and download your patient forms here.