Patient Forms

If you are a new patient to our office, the attached files contain our new patient forms that will need to be filled out when you arrive at our Benton dental office. Printing them, filling them out and bringing them with you will allow us to attend to you more quickly than completing them on your arrival. Thank you and please call our office at (501) 778-7129 should you have any questions at all.

NEW PATIENT FORMS

NOTICE OF PRIVACY PRACTICES

ACKNOWLEDGEMENT OF NOTICE OF PRIVACY PRACTICES

AUTHORIZATION FOR RELEASE OF IDENTIFYING HEALTH INFORMATION

 

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