544 FM 156 South, Suite 100
Haslet, TX 76052

​Phone: (817)439-4999
Fax: (817)439-8999

Please print and fill out the following forms and bring them with you to your child's first appointment as this will save you waiting time during check-in.

Financial_Policy.pdf  


Notice_Of_Privacy_Practice.pdf


Notice_Of_Electronic_Disclosure.pdf


Patient_Authorization_Release_Of_Protected_Health_Info_Records.pdf


Acknowledgement_of_Privacy_Practices.pdf


Patient_Medical_History.pdf


Parent_Information.pdf


Consent_Form.pdf


Release_Of_Consent.pdf


For your  child's six month check up appointment please print and fill out the following form.


Medical_History_Update.pdf


If your child is under the age of three please print and fill out the following state forms for every dental visit. 


FDH_Dental_Risk_Assessment_Questionnaire_ENG-SPN.pdf


FDH_Oral_Health_History_Questionnaire_ENG-SPN.pdf


Forms