Patient Forms

ON BEHALF OF OUR ENTIRE STAFF, WELCOME TO OUR PRACTICE! 

We take great pride in the quality of our work and facilities, so you receive the highest quality care available. Please be assured that we will do everything within our power to make you feel comfortable and at ease.

 

YOUR INITIAL VISIT WITH DR. DALESSANDRO WILL INCLUDE:

  • A review of your medical and dental history.
  • A complete examination of your mouth and review of your X-rays.
  • An explanation of Doctor's findings; you will be given several options to achieve optimal health.
  • A treatment plan presented to you with the goal of bringing you back toward optimum periodontal health.

 

IN ORDER FOR YOUR CONSULTATION APPOINTMENT TO PROCEED AS SMOOTHLY AS POSSIBLE, WE ASK THAT YOU:

  • Complete the New Patient forms via the link we sent you when you made your appointment with us.
    • We ask that these completed forms be submitted to us 3 business days before your scheduled appointment. 
    • If you haven't received the link, please check your Spam folder, or contact our office so we can re-send it to you.
  • Bring a current, valid photo ID such as a Drivers License or State Issued ID.
  • Bring any additional materials your dentist may have given you (this may include a referral slip, xrays, or scans).
  • Bring your Dental Insurance ID card if you have dental benefits.

 

Please note that if a procedure is scheduled as part of your treatment plan, we do ask for a procedure deposit in addition to the consultation fee.

 

PRINTABLE FORMS

If you have trouble using the online form, you can also print and fill out the forms & bring them to your visit with us:

  • Medical History | PDF
  • Dental History | PDF
  • Patient Information | PDF
  • Consent Form | PDF
  • Financial Policy | PDF
  • HIPAA Compliant Notice of Privacy Practices | PDF

If you're unable to open PDF files, you can get Adobe Reader® for free.

 

​LOCATION

For your convenience, a map with directions to our office can be found under the Contact Us section of our website. We look forward to meeting you and to working together to regain and maintain your oral health. 

Back to Top