Patient Forms

For new patients, figuring out what you need prior to your first visit can feel a bit overwhelming. At Walton Center for Family Dentistry, our dedicated team is here to help.

Having these dental patient forms ready before coming in can make the check-in process easier, as well as lessen anxiety over the initial dental appointment. Studies have found that one-third of the U.S. population experiences some kind of dental anxiety or fear. We’ll work with you to alleviate these fears. 

Our team is always here to answer any questions regarding information covered on your patient forms. We also have resources available on our website for specific concerns related to financing and insurance.

There are four forms we’ll ask you to have completed before you come in. Each of these forms can be downloaded and printed below. After you’ve filled them out, simply bring them in along with your dental insurance card and a form of personal identification, like a driver’s license. You’ll also want to be sure to have an available form of payment for any copays or out-of-pocket costs. And don’t forget to arrive 10 minutes early so you can settle in and check everything off before you’re called back!

Whether it’s your first time visiting our Walton office or it’s your first time ever going to the dentist, we offer comprehensive, best in class care with your comfort in mind.

Breaking Down the Details

The purpose of these dental patient forms is to inform patients of their rights and responsibilities. Our priority is on promoting proper communication between the patient and the practice, while continuing our history of providing compassionate care. The forms don’t take long to fill out and, if you’d like to know the reason behind each one, here’s what you can expect:

New Patient Registration

These patient information forms include all of the basic information we need to get to know you and your history prior to your first appointment. It covers things like insurance, contact information and emergency contacts. By signing this, you authorize the dentist to provide proper dental care, accept responsibility for services rendered, and attest to the accuracy of the provided information.

Filling this form out at home also gives you time to double check and confirm your medical and dental health history without the pressure of figuring it out while sitting in the waiting room. It’s important that we have complete information regarding your history as well as any allergies or medications you’re currently taking. This information allows us to provide the most effective, appropriate care with a customized plan suited to your health needs.

X-Ray Release Form

The signature on this form authorizes the release of X-rays. We can send them to your personal address or an alternative dental office. We can also send a digital copy to the email listed on this form. The purpose is to obtain patient permission for sending private dental records.

Practice Policies

These forms cover our practice’s non-discrimination, financial and privacy policies, as well as patients’ rights and responsibilities. It’s important to us that our patients are fully aware of the responsibilities and rights listed below. They are intended as a guide to help the development of a successful and collaborative dentist-patient relationship.

You can find the full list of rights, responsibilities and practice policies in the corresponding downloadable form.

HIPAA Communication Form

The purpose of this last patient form is to notify patients on how their health information is being used and shared. Patient privacy is important to us. Detailed within these forms is our policy to keep patient health information confidential and not disclose such information without your consent or written authorization unless otherwise required by federal or state privacy laws.

You have a right to be aware of who your information is being communicated to and how it is being communicated. These policies also make sure you’re staying well-informed on upcoming appointments and other pertinent medical information.

All dental patient forms must be completed before being seen by a licensed dentist. This includes the new patient registration forms, financial agreements and other relevant documents found online and easily downloaded for your convenience.

The team at Walton Center for Family Dentistry is focused on providing open communication to each and every patient. You can reach out online with any follow-up questions, schedule an appointment today, or call us at 770-450-2030.

We look forward to getting to know you and your family!