All new patients must sign our Acknowledgement Form confirming they received and acknowledge our Privacy Practices. Do not sign this form until you have not downloaded and reviewed our Notice of Privacy Practices above.  Filling this out before your office visit minimizes your wait time and helps our staff. You may select Download to print or select Complete Now for instant online submission.

All new patients must complete the Patient Information and Medical History. If this is your first visit to our office in 2017, you will need to complete these forms again. Filling these out before your office visit minimizes your wait time and helps our staff. You may Download to print or select Complete Forms Now for instant online submission.

New Patient Info and Medical History (Review and Signature Required)

2017 Clinic Policy (Review and Signature Required)

All new patients must review and sign our updated Clinic Policy. If this is your first visit to our office in 2017, you will need to complete this form again since it has changed. Filling this out before your office visit minimizes your wait time and helps our staff. You may select Download to print or  select Complete Forms Now for instant online submission.

All new patients must review our Privacy Practices before signing they received and acknowledge these policies.  Filling this out before your office visit minimizes your wait time and helps our staff. You may select Download to print or select Complete Now for instant online submission.

Notice of Privacy Practices (Review Required)

Get ahead by submitting your new patient forms before your office visit

DENTAL HEALTH ARLINGTON

Acknowledgement of Privacy Practices (Signature Required)

Proof of Income, Proof of Tarrant County Residency, and Government Issued Photo ID must be shown for EACH appointment. For your convenience, you may upload any or all of these documents right here on our site. Please keep in mind, if text in  an image is illegible it will not serve as an acceptable document. Additionally, please remember all documents must be current and unexpired.

Upload Your Documents

Phone: (817) 277-1165

Fax: (817) 277-1106

501 W. Sanford St., Ste 11

Arlington, TX 76011

Mon- Thurs:  8:00am - 4:00pm 

© 2015

by Dental Health Arlington.