Patient Forms

You can pre-register with our office by filling in the Patient forms below. After completing the forms, remember to press the Submit button. Your information will automatically be entered into our system, saving you from refilling them during your initial visit. Rest assured, all information collected online is encrypted to ensure your privacy.

If you are a new patient to our office, you may complete the online form below.
Thank you, and please feel free to contact our office if you have any questions.

Please note that all patients under 18 must be accompanied by a parent or guardian at the consultation appointment.

 

New Patient

New Patient Registration Form Open Form
Dental Release Form: New Patients
Authorization to Release Dental Records to Blossom Dental		 Open Form
Medical History Open Form

 

 

Share your records

Dental Release Form: Existing Patients
Authorization to Release Dental Records from Blossom Dental		 Open Form

 

 

 

For your initial visit, kindly provide the following:

 

  1. A comprehensive medical and dental history.

  2. A list of medications you are currently taking.

  3. If you've had any X-rays in the last year, please email them to us at smile@blossom-dental.com before your visit.

  4. If you have insurance, please bring any forms or insurance benefit cards (both dental and medical) to the appointment.