existing patients
For Existing Patients
Existing patients can update their health history and insurance information using the forms here. If you are looking for a consent form please scroll down, then print and fill out the necessary form(s). Pre and post treatment instructions are also available for your convenience.
New & Existing
Patient Forms
PHone
(901) 761-3770
Address
6268 Poplar Ave.
Memphis, TN, 38119
1122 Poplar View Ln N
Collierville, TN 38017
1. PRE & POST TREATMENT INSTRUCTIONS
Addendums to General Pre/Post Treatment Instructions
(below are additional instructions which may be used in addition to your General Pre/Post Treatment Instructions)
- General Pre-Post Op Instructions
- Pre-Post Op Instructions 6.18.21
- Post LANAP Instructions
- Esthetic Crown Lengthening, Soft Tissue Graft, Ridge Augmentation, Frenectomy, Wilckodontics Or Orthodontic Uncovery Pre & Post Treatment Instructions
- Post Implant Instructions
- Extraction Treatment Pre & Post Treatment Instructions
- Sinus Lift Pre- Post Instructions
NOTE: All Pre- and Post-Treatment Instructions must be reviewed with our team members.
2. CONSENT FORMS
- General Consent Form
- Sedation Consent
- Patient Transportation
- Laser Assisted New Attachment Procedure (LANAP) Consent Form
- Trimera Identafi 3000 Consent Form
- Non-Surgical Scaling and Root Planing Consent
NOTE: All Consent Forms must be reviewed with our team members.
3. HEALTH HISTORY (EVERY 6 MONTHS TO 1 YEAR)
4. INSURANCE INFORMATION/ UPDATE (IF YOU HAVE A CHANGE IN INSURANCE, PLEASE FILL THIS OUT)
5. BLEACH RINSE INSTRUCTIONS
6. PRIVACY POLICY
