PATIENT FORMS

NEW PATIENT

Forms And Information

Help us get to know you better AND help speed up the process of getting in to see Dr. HagShenas on your first visit with us!

Before you come in for your first visit, we invite you to download and complete our New Patient forms. We need these forms to ensure you receive the very best care available.

We’ve also found that by completing these forms prior to your initial visit, you’ll be much more relaxed knowing that you won’t have to worry about taking care of this ‘not much fun’, but very necessary step.

A. PATIENT INFORMATION B. HEALTH HISTORY FORM C. DENTAL HISTORY FORM D. INSURANCE INFO. FORM

Get In Touch

Fill out the form below to request a consultation or ask a question. You can also request a video consultation.

I understand the information disclosed in this form may be subject to re-disclosure and may no longer be protected by HIPAA privacy regulations and the HITECH Act.