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212-645-9255!

Meet the Doctor | Our Office | Patient Services | Care Philosophy | Smile Gallery

Patient Forms

We appreciate that your time is valuable. That's why we give you the option of completing your paperwork in the comfort of your own home. Simply complete the forms online (click on the globe icon), and email it to us. If you'd prefer, you can print the forms (please click on the pdf icon), complete the information, then mail them to us or fax them to (212) 645-9392 or
email us

• If you would like to fill and complete the forms online and submit to us electronically, please click on the next to the form name.
• If you would like to print and handwrite the form and submit to us by fax or mail, click next to the form name.

HIPAA Privacy Practices


	Dental History
	Patient Information
	Patient Information - International
	Medical History
	Consent For Teeth Whitening
	Post- Surgical Procedures/ Instructions
	Teeth Whitening
	Consent For Dental-Alveolar Surgery
	Insurance Information
	Easy Pay Consent Form