Patient Forms

New Patients

You may access the following forms to assist us with your care. Please print and fill out the following forms, then bring them to your appointment.

  • New Patient, Consent for Treatment and Health History Forms – required information for all new patients, including information about your general health, current medications, allergies, medical conditions and prior dental care
  • 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.
  • HIPAA Notice – describes how health information about you as a patient of Dr. Rogers’ practice may be used and disclosed.

Existing Patients

You may access the following form to assist us with your care. Please print and fill out the following form, then bring it to your appointment.