Online Patient Forms

In our effort to help reduce the risk of transmission of germs that could cause the spread of infectious disease such as COVID-19 —now you can submit our Patient Forms online! Our hope is to provide our patients with more “contactless yet safe & secure solutions” to retrieving some of our Patient Forms.

COVID-19 Online Patient Files

Specific Online Patient Forms in direct response to new COVID-19 safety protocol.

COVID-19 Protocol:
Please observe our new office policies to help mitigate risks of infection within our dental office.

Screening Form:
This form helps us gauge any potential signs of symptoms prior to being seen by one of our dentists.

Ask Dr. Mora
Appointment Request
We are currently limiting our appointments to emergency visits. Contact us for more information.

Online Patient Forms Directory

Here you can fill out our patient forms prior to your schedualed appointment.

Adult - Patient Form:
For new Adult patients, including returning patients who may need to update their patient information.

Minor - Patient Form:
This patient form is meant to be completed by the legal guardian and or parent of a minor.

Patient HIPAA Questionnaire:
HIPAA is concerned with protecting the means in which your personal, private info is collected, stored, or transmitted to our office.

Adobe PDF Reader:

Adobe Acrobat Reader is the single most powerful, free, and trusted standard for viewing, printing, and annotating PDF files.

Can't open a file? Install the latest version of Adobe PDF Reader onto your computer, and please check your app store for the appropriate Adobe PDF Reader App for your mobile device.

Patient Forms Directory

Here you can download our patient forms and review the information prior to your first appointment. You may fill out the form at home or in our office.

Adult - Patient Form:
This patient form is specifically for our Adult patients.

Minor - Patient Form:
This patient form is meant to be completed by the legal guardian and or parent of a minor.

HIPAA Policy
This form acknowledges you have been well informed of your privacy rights with respect to the personal health information you provided us.

Patient Files

For your reference, you can download our Patient Files to keep for your records.

Care After Fillings:
Download this PDF file to reference helpful Care After Fillings tips.

Care After Extraction:
Download this PDF file to reference helpful Care After Extraction tips.

Financial Policy
We feel that everyone benefits when there is a definite and clear understanding of our financial policy prior to treatment.