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 Patient Insurance questionnaire.

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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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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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