Forms

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  

209.5 KB


Notice_of_Privacy_Practices.pdf

102.0 KB


Acknowledgement_of_Privacy_Practices.pdf

242.4 KB


Patient_Medical_History.pdf

637.8 KB


Parent_Information.pdf

144.9 KB


General_Treatment_Consent.pdf

417.3 KB


Release_Of_Consent.pdf

189.5 KB


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


Medical_History_Update.pdf

340.9 KB


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

70.7 KB


FDH_Oral_Health_History_Questionnaire_ENG-SPN.pdf

36.5 KB