Davis & Dingle Family Dentistry

Office Hours

Payment Options

Apply From Home
Care Credit
Chase Healthcare

Patient Forms

These patient forms will help expedite our services when you come into our practice. Please download and print the necessary forms, fill them out and bring them to your appointment.

Patient Forms

New Patient Forms (please bring completed forms with you to your 1st appointment):
Patient Information
Informacien del Paciente (For Spanish Speaking Clients)
Patient Dental History
Acknowledgement of Receipt of Notice of Privacy Practices

Forms for patients we have not seen for more than 6 months:
Consent for Use and Disclosure of Health Information
Notice of Privacy Practices
Medical History Update
Acknowledgement of Receipt of Notice of Privacy Practices

For Patients requesting x-rays:
Consent for Use and Disclosure of Health Information