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).

Med History Update (Necessary for each cleaning visit, every 6 months)

COVID-19 Pre-screening Form (Necessary for each visit)*

Medical/Dental History Form (New patient form. Only needed for 1st time patients.)


Treatment Consent Form (Necessary for your child's 1st visit.)


HIPAA Acknowledgement Form (Necessary for your child's 1st visit.)

Behavioral Assessment Form (For special needs children.)


*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.

Document with Pen

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