You may access the following forms to assist us with your care. You can open the first links, fill out the forms and submit them directly to our office, or you may print and fill out the forms by clicking on the second set of links. Please bring these forms with you to your appointment.
Online Forms
Printable Forms
- New Patient and Consent for Treatment – required information for all new patients
- Health History – provides information about your general health, including current mediations, allergies, medical conditions and prior dental care
- HIPAA Notice – describes how health information about you as a patient of Dr. Rogers’ practice may be used and disclosed
- Office Policy Form – describes the payment requirements for each appointment, how insurance is handled and the importance of timely payments and prompt appointment visits to our office
*These forms require Adobe Acrobat Reader to view. If you do not have Adobe Reader already installed on your computer, click the Adobe logo above to download.
**We are committed to keeping your personal information secure. All of our online forms are submitted via a secure connection and are HIPAA compliant.
***For Apple/Mac Users: You must use Adobe Acrobat Reader to submit the forms. To do so, simply right click on the form and save form. Open form in Acrobat Reader, fill out the form and submit.