Patient Forms

 
845-471-4383

Patient Forms 


New Patient Forms

Medical History Form

HIPPA Notice of Private Practice Form

Smile Evaluation 


Informed Consents for Treatment

Consent for Biopsy

Consent for Extraction

COVID-19 Pandemic Emergency Dental Treatment Consent

Consent for Endodontic Treatment (Root Canal)

Consent for Invisialign Treatment

Consent for Zoom Teeth Whitening Treatment

COVID-19 Patient Advisory And Acknowledgment 


Post Operative Instructions

Post-op-instructions (Extractions)


Other Forms

Patient Photo Release Form

Healthy Smiles

What does your smile say about you? Let us help you radiate confidence with a healthy smile.

Testimonials Contact Us

Testimonials

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Manisha Bhalla, DMD
46 Fox St, Suite 2 Poughkeepsie, NY 12601
Phone: (845) 471-4383 URL of Map