DeFries Family Dental » Digital Forms
Digital Forms
Need to update your health history with our office? Coming in as a new patient? Need to transfer records? No worries! You can find all our digital forms below.
New Patient Information
New patient? Use this form to complete all your paperwork prior to your appointment.
*This link includes all health history and record request paperwork as well.*
New Patient Form
Record Release
Need images or records sent from our office to another office? Use this form.
Record Release Form
Record Request
Planning to have images or records sent to our office? Use this form below.
*Make sure to list contact information for your previous office.*
Record Request Form
Health History Information
Current patient, but had a change in health history? Use the following form to bypass all our other forms and just update your health history.
Health History Information Form
Personal Information
Insurance change? Use this form to update all your personal contact information, including your emergency contact and responsible party information.
Personal Information Form
HIPAA
Just want to view our HIPAA policy? This form has what you need.
HIPAA Form