New Patient Forms
Are you a new patient?
Your first visit to Plage Dentistry establishes a vital foundation for our relationship with you. During the first visit we make sure to obtain important information, such as your medical and dental history. To understand what to expect at your first visit to our practice, please read through this page. You’ll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. There’s also information about our committed staff and our first visit procedures. For your convenience you can even print out and complete the patient forms in advance of your appointment and bring them with you.
Mission Statement
Our practice is working together to realize a shared vision of uncompromising excellence in dentistry.
To fulfill this mission, we are committed to:
- Listening to those we are privileged to serve.
- Earn the trust and respect of patients, profession and community.
- Exceed your expectations.
- Ensure a creative, challenging and compassionate professional environment.
- Strive for continuous improvement at all levels.
Patient Forms
Please click on a link to access the digital form(s)…
Once you have entered your information, a “submit” button will be present at the bottom of each form:
- New Patient Registration
- Medical History Form
- Medical History Form (Spanish)
- HIPAA (English) & Acknowledgement of Privacy Policy
- HIPAA (Spanish)
- Patient Registration (Spanish)
- Records Release (Spanish)
- Release of Records – (Send Records to Our Office)
- New Release of Records
- Cancellation Policy
What To Expect
Being well-prepared for your appointment will ensure that the doctor and his staff have all of the needed information to provide the best possible care for you. Please be sure to bring a complete list of any medications you are currently taking. Please contact any previous dentists including specialists to arrange to have your records, including x-rays, sent to us. If you would prefer, a member of our staff would be happy to request your records for you. You will need to allow up to 2 weeks for us to receive any records. We can accept electronic records and x-rays at the following email address: office@plagedentistry.com.