New Patient Forms
By filling out these forms ahead of time you will save significant time on your visit. If you have any questions when filling out the form, please do the best you can, and our staff will assist you with your questions on the day of your appointment.
Digital Forms
The following forms can be filled and submitted online from any device (phone, tablet, laptop or desktop). At the end use your finger or mouse to sign the forms digitally.
New Patients
- Medical/Dental History (Adult)
- Medical/Dental History (Child)
- Dental Records Release
- Personal Information Consent
By Request Only
- Consent for Crown Lengthening
- Consent for Crowns & Bridge Prosthetics
- Consent for Endodontic Treatment
- Consent for Fillings
- Consent for Extraction of Teeth
- Consent for Impacted Tooth Treatment
- Consent for Bone Graft Surgery
- Consent for Gingival Grafting Surgery
- Consent for Implant Removal
- Consent for Implant Surgery
- Consent for Maxillary Sinus Elevation Surgery
- Consent for Nitrous Oxide/Oxygen Sedation
- Consent for Root Canal Treatment
- Consent for Social Media
Fillable and Savable PDFs
The following forms can be downloaded to your computer, open and fill them with Adobe Reader. Send the filled forms via email to towncentredental@rogers.com.
New Patients
- Medical/Dental History (Adult)
- Medical/Dental History (Child)
- Dental Records Release
- Personal Information Consent
By Request Only
- Consent for Crown Lengthening
- Consent for Crowns & Bridge Prosthetics
- Consent for Endodontic Treatment
- Consent for Fillings
- Consent for Extraction of Teeth
- Consent for Impacted Tooth Treatment
- Consent for Bone Graft Surgery
- Consent for Gingival Grafting Surgery
- Consent for Implant Removal
- Consent for Implant Surgery
- Consent for Maxillary Sinus Elevation Surgery
- Consent for Nitrous Oxide/Oxygen Sedation
- Consent for Root Canal Treatment
- Consent for Social Media
Technical Note:
Our online forms use the Adobe Acrobat Plugin.
Please download the free plug-in from Adobe's website if it is not already installed on your system. It is important that you have the latest version, in order to open, fill and save our forms.
