Please print out and complete all 4 forms. The "New Patient Forms", "HIPAA Acknowledgement" and "Credit Policy" can be emailed to us at: info[at]LonsdaleFamilyDental.com, dropped off at our office during business hours, or dropped in our lock box near the front door.
Please fill out the Release of Information and give it to your previous dentist so that they can forward your records to us prior to your first visit.
1) NEW PATIENT FORMS BUNDLE
2) RELEASE OF INFORMATION (SUBMIT TO YOUR PREVIOUS DENTAL OFFICE TO HAVE RECORDS TRANSFERRED TO US)
~ BOTH OF THE ABOVE LINKS WILL OPEN PDF DOCUMENTS FOR YOU TO SAVE OR PRINT ~
This is the full HIPAA form if you wish to review it. It is for your information and 'Read Only' (No Need to Print)
HIPAA POLICY - NEW 08.doc