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) 300-4162

Address

6268 Poplar Ave.

Memphis, TN, 38119

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)

NOTE: All Pre- and Post-Treatment Instructions must be reviewed with our team members.

2. CONSENT FORMS

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