Forms

New Patient Form

New patient? Submit all necessary information online with our safe, encrypted, and HIPAA-compliant form!

New Patient Form | Printable PDF

Release of Protected Health Information

Need to have your protected health information sent to us at Fairmount Dental? Fill out this form!

Authorization to Release Health Information | Printable PDF

Financial Policy

Review and sign our financial policy.

Financial Policy | Printable PDF

Missed Appointment Policy

Review and sign our missed appointment policy here.

Missed Appointment Policy | Printable PDF

Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Acknowledgement of Privacy Practices | Printable PDF | Full Notice of Privacy Practices