Adult New Patient Forms
We are asking you to complete new patient questionnaire enabling our clinical and administrative staff to prepare for your first visit and to make your check-in for your appointment quicker and easier.
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Existing Adult Patient Update
As an existing patient, we are asking you to complete two forms. Our Medical History form and the current COVID-19 questionnaire.
PreViser Questionnaire
Our PreViser questionnaire will give us additional information about your individual risk for oral diseases, such as tooth decay and gum disease, along with some actions you can take to reduce the risk.
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Child New Patient Forms
We are asking you to complete new patient questionnaire for your child to enable our clinical and administrative staff to prepare for your first visit and to make your check-in for your appointment quicker and easier.
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Existing Child Patient Update
As an existing patient, we are asking you to complete two forms for your child. Our Medical History form and the current COVID-19 questionnaire.
Release of Records Forms
We are asking you to authorize the release of your/your family's (if applicable) dental records, including radiographs, charting and progress notes to the office of Salem Family and Cosmetic Dentistry.
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COVID Questionnaire
We are asking you to complete a COVID questionnaire to establish that you do not currently have any of the listed signs or symptoms of COVID-19.
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Get in Touch.
Contact our team today to create a patient care plan that is best for you.