Please click on the links below to access our patient intake online fillable forms.

COVID-19 Forms

Patient Pre Screening

Patient In-Office Screening

Pandemic Dental Treatment Consent

Medical/Dental Forms

New Patient Information

Patient Information and History

Patient Information Update

Medical and Dental History v.3

Medical and Dental History v.4

Medical Questionnaire

Medical History Update v.3

Medical and Dental History for Children v.1

Medical and Dental History for Children v.2

Health History Questionnaire (RDH)

Dental History

Consent Forms

Personal Health Information Consent

Personal Information Consent v.3

Confidential Information Questionnaire

Financial Agreements, Office Policy, and Pediatric Consent

Dental Records Release v.1 (Family)

Dental Records Release v.2 (Periodontal)

Dental Records Release v.3 (Specific Films and Exams)

Insurance Forms

Dental Insurance v.2

Dental Insurance v.3

Insurance and Billing

Insurance Update

Other Forms

Instructions: The forms can be filled and submitted using any mobile or desktop web browser (Microsoft Edge, Safari or Chrome, Android or IOS). The online forms are securely submitted and collected using secure encryption protocols. If you require further assistance or have questions regarding how we safeguard your private information please do not hesitate to contact us directly at 780-471-0885 or 587-773-4525 to speak with a scheduling coordinator.