Patient Forms

Click on the links below to download our new patient forms. For convenience purposes you may fill them out and bring the completed forms with you to your first appointment. These forms are also available in our office. Please arrive 15 minutes before your first scheduled appointment. 

 

If you have any questions about these forms or policies, please write down any concerns you may want to discuss with Dr. Bingham and bring your questions to your appointment. 

New Patient Forms

Download
Privacy Policy Acknowledgement and Insurance Release
Privacy Policy Acknowledgement and Insur
Adobe Acrobat Document 57.8 KB
Download
Endodontic Conset and Information Form
Endodontic Consent and Information Form.
Adobe Acrobat Document 379.5 KB
Download
Patient Information Form
Patient Information Form.pdf
Adobe Acrobat Document 152.7 KB

Privacy Policy

Download
Full HIPAA Privacy Policy
HIPAA Privacy Policy .pdf
Adobe Acrobat Document 116.3 KB

Printable Map to Our Office

Download
Printable Map
Map.pdf
Adobe Acrobat Document 196.2 KB