Smiles on 146th Street New Patient Form

If you have made an appointment with our office as a new patient, you can expedite the check in process by downloading the Health History Questionnaire and Patient Information Forms below, completing them, signing where appropriate, and faxing them to our office at (317) 214-4188. You may also bring them in at your designated appointment.

Patients are often confused as to the reasons why they need to fill out medical and dental history forms. People often do not realize how their dental health affects their physical health and how their physical health affects their dental health.

Dental exams can reveal gum disease, cavities, oral cancer, poor oral health conditions that are linked to diabetes, heart disease and poor overall health. Because of how these risk factors are related to each other you will be asked additional questions regarding your health.

Please note that we advise all new patients to allot extra time to come to your first appointment 30 minutes in advance to complete the check in process. It takes less time if these froms are completed.

Please Click on Icons for PDF Downloads
	New Patient Welcome Letter
	New Patient Health History Questionnaire
	New Patient Registration Form
	Consent for Treatment Form
	Cosmetic Treatment Questionaire (Optional but Helpful)
	Privacy Policy (Please Print for your Records)
	Model Release Form (If your photo is used on website or in media)

Please remember to fax or bring your completed forms with you for your first appointment. If you have any problem getting these files to print properly, please call our office and we will gladly mail or fax them to you.