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Patient Forms

New Cleveland TX Dental Patient Forms 

For your convenience we have made a variety of our Patient Forms available online. Please print and complete these forms prior to your visit so that we may attend to your needs more quickly. If you have any questions please contact us at our Cleveland, TX dental practice today! If you are a new patient please fill these out and you information will be sent directly to our office:

ONLINE New Patient Forms

Online New Patient Forms **************These forms will directly import into the Office's computer) If you have any difficulty and are unable to do these or require a Spanish version,then you can print below the form that you need, fill it and bring to the office with you)

New Patients--Please fill out all forms.

Existing Patients--Please fill out Medical History and Patient Screening Form only. 

Patient Forms (only if unable to fill out the above Online Form)

New Patient English Form      
New Patient Spanish Form    

HIPAA Communication Form

HIPAA Communication Form (Spanish)

Recall Forms

English

Spanish

COVID SCREENING FORMS:

English 

Spanish

Medicaid Home Care

Home Care Questionnaire English    
Home Care Questionnaire Spanish