Download New Patient Forms
For your convenience…
Please help us be prepared for your first appointment by completing these Patient Information and Medical History forms. Download the form below (in PDF format) to your computer, print it out, complete the form, and bring it with you to your first appointment.
- Medical History (PDF)
- Patient Information (PDF)
- Acknowledgement of Receipt (PDF)
- Privacy Notice (PDF)
- Patient Questionnaire – Form for children ages 10 and under (PDF)
- Patient Questionnaire – Form for patients ages 11 and up (PDF)
- The Epworth Sleepiness Scale – ADULT (PDF)
- Pediatric Sleep Questionnaire – CHILD (PDF)
- Consent for Communication Non-Secure (PDF)
- Release Form for Website Photos/Facebook/Videos (PDF)
If you’re unable to read PDF files, you can download Acrobat Reader free from Adobe.
Please do not use this form to cancel or change an existing appointment.
*Items marked with a star are required.
Dr. P and the entire staff here really are the best. Not only do they fix smiles… but they make sure to greet you with one the moment you walk through the door.
Couldn’t have been happier with the service, price and – most importantly – the end result.
Eddie M.