Forms for New Patients

Please fill out these forms at home. Be sure to bring them with you to your next appointment or submit through e-mail.

  • Patient 
Registration Form

    This form is for patients registering for the first time at our practice. Info includes your name, address, insurance details, etc.

  • Medical History Questionnaire

    Providing info such as prescribed and non-prescribed medications will help us provide the safest dental care for you.

  • X-Ray & Patient Chart 
Release Form

    This release form will let us request access to your patient records from your previous dentist.

Physician Examination Pre-Anaesthetic Form

If requested by Dr. Midroni, the Physician Examination Pre-Anaesthetic Form will need to be completed by your family physician prior to your sedation appointment.

  • Physician Examination 
Pre-Anaesthetic Form

    Print this form in the comfort of your home, and bring to your Physician/MD to fill out.