Form Center
Below you will find all of the frequently used Patient Forms for our practice. You can take a look at any form and you may be asked to download and fill out a form when scheduling an appointment at any of Northland Smiles offices. These forms all require the use or Adobe Acrobat Reader which can be downloaded by clicking the image at the bottom of the page.
New Patient Forms |
To save you some time, please fill this form out before arriving on your first visit |
| Medical History Form | |
| HIPAA Form | |
| Signature Form | |
Consent Forms |
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| Consent for Minor Child | A consent form for treatment of your minor child |
| Consent for Special Needs | A consent form for treatment special health care needs |
Prepay Plan |
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| Prepay Plan Information | Information on our prepay dental plan (an alternative to dental insurance) |
Forms on this page require Adobe Acrobat Reader.
To download Adobe Acrobat Reader, click the image below.
To download Adobe Acrobat Reader, click the image below.