EN

Translate:

2nd Location Now Open in Northlake on FM 407

544 FM 156 South, Suite 100, Haslet, TX 76052

(817) 439-4999

(817) 439-4999

  • Home
  • Meet the Doctors
  • Meet the Staff
  • Services
  • Forms
  • Office Tour
  • Sedation
  • Sedation Instructions
  • First Visit
  • LightScalpel Laser
  • Post-Op Care
  • Dental Emergencies
  • Oral Health Care
    • General Dental Topics
    • Early Infant Oral Care
    • Preventative Dentistry
    • Adolescent Dentistry
    • Special Needs Patients
  • Guatemala
  • More
    • Home
    • Meet the Doctors
    • Meet the Staff
    • Services
    • Forms
    • Office Tour
    • Sedation
    • Sedation Instructions
    • First Visit
    • LightScalpel Laser
    • Post-Op Care
    • Dental Emergencies
    • Oral Health Care
      • General Dental Topics
      • Early Infant Oral Care
      • Preventative Dentistry
      • Adolescent Dentistry
      • Special Needs Patients
    • Guatemala

EN

  • Home
  • Meet the Doctors
  • Meet the Staff
  • Services
  • Forms
  • Office Tour
  • Sedation
  • Sedation Instructions
  • First Visit
  • LightScalpel Laser
  • Post-Op Care
  • Dental Emergencies
  • Oral Health Care
  • Guatemala

New Patient

English

Nuevo Paciente

Español

Medical History Update

English

Actualización de Historia Médica

Español

Forms

Please print and fill out the following forms and bring them with you to your child's first appointment as this will save you waiting time during check-in.

Financial Agreement (pdf)Download
Notice of Privacy Practices (pdf)Download
Notice of Electronic Disclosure (pdf)Download
Patient Authorization Release of Protected Health Information Records (pdf)Download
Acknowledgment of Privacy Practices (pdf)Download
Patient Medical History (pdf)Download
Parent Information (pdf)Download
Consent Form (pdf)Download
Release of Consent (pdf)Download

If your child is under the age of three please print and fill out the following state forms for every dental visit. 

Dental Risk Assessment Questionnaire (pdf)Download
Oral Health Questionnaire Eng/Spn (pdf)Download

For your  child's six month check up appointment please print and fill out the following form.

Medical History Update (pdf)Download

Copyright © 2018 Pediatric Dentistry of Haslet - All Rights Reserved.

Powered by GoDaddy Website Builder