863 Main St

Hackensack, NJ 07601-4907

(201) 489-7575

New Patient Forms

Welcome to our practice. Thank you for taking the time to read this informational letter. Attached are several forms to be completed prior to your first appointment.

We appreciate you completing our new patient forms prior to your appointment. Any questions you have regarding these forms and/or our office policies should be brought to our attention as soon as possible and certainly prior to treatment. A photograph will be taken of you for your personal health information file. In addition, please bring a list of all medications being taken to include physician’s prescriptions, over the counter remedies and herbal compounds.

Please bring with you the following documents:

If you are unable to keep your personal appointment time, please provide our office with 48 hours notice; if not, we reserve the right to charge for the time reserved. We understand that your time is valuable, as is our own. We do our best to keep on schedule. Therefore, we ask that you arrive 15 minutes prior to your scheduled appointment time to allow us to prepare your file and answer all your questions. Initial appointments are one hour.

A custodial parent of legal guardian must accompany minors for all visits.
We look forward to meeting and working with you on your path to dental health and wellness. If we can answer any questions prior to your appointment, do not hesitate to contact our office.

We recognize that your time is valuable. We will make every attempt to honor your scheduled appointment time. To save time, please download our New Patient Registration Form. This may be easily completed using your keyboard and mouse. Print the completed form and fax it to us or bring it with you when you come in for your first appointment.

To print our New Patient Registration Form, please click on the link above. You will need Acrobat Reader, which is a free software program available by clicking the Get Adobe Reader button below.

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