Dental Health Guides
New Patient Forms
Please print all forms listed below and bring them to your appointment. You can also fax the forms to 574-968-0689.
Effective Friday, May 1, 2009, the FTC has implemented proposed “Red Flags Rule.” This requires all covered entities in America to put into place a program designed to detect identity theft.
Therefore, our office will require a photo ID with all new or non-established patients, if you do not have a photo ID, please call our office for alternative forms of identification.
If you have any questions regarding “Red Flags Rule” please visit the FTC’s website at www.ftc.gov .
New Patient Forms