ADvanced DENTISTRY | PRINT PATIENT FORMS in Cheshire

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Dr. Amit V. Desai & Dr. Colleen Caulfield Randall

General Dentistry featuring Cosmetic & Restorative Treatment


PRINT PATIENT FORMS

WELCOME

In this menu, we have provided you the links to print and complete your new patient forms in the comfort of your own home by clicking on the menu and choosing the appropriate documents 

 

Each new patient (adult and child) will require a New Patient Registration form, an Office Guideline form, A Medical History Form and a Notice of Privacy Practice form.

  • Anyone over the age of 14 is requested to complete the Adult Medical History form. 
  • Anyone that would like us to request records from a privious dentist or dental facility will need to complete the Release of Records Form.  For your convenience and to expedite the transfer of records this form may be faxed to us at (203) 272-8882.


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    Please do not submit any Protected Health Information (PHI).