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Dynasty Dental | New Patient Forms in Allen

 

Dynasty Dental


717 S. Greenville Ave Suite 114
Allen, TX 75002

(214) 547-8628

New Patient Forms

 

We know you have a busy schedule. To save time at your first appointment, you can download both the forms below. Fill them out before your visit and bring them with you!

 

1. New Patient Form (Adults)

2. Other Required New Patient Forms

Includes:

  • Notice of Privacy Practices (Your Copy)
  • Assignment of Benefits and Payment Agreement
  • Consent for Use and Disclosure of Health Information
  • Acknowledgement of Receipt of Notice of Privacy Practices
  • Dental Treatment Consent Form 

 

Call (214) 547-8628 for an appointment now!

Be sure to bring along your insurance and identification card and you're all set! 

 
 
 
Allen Dentist | New Patient Forms. Janet Tran is a Allen Dentist.