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Patient Forms

We have provided the main forms here on our web site that we will need from you when you visit our office and that provides information about our services, no show policy, etc.

Below is a short description of each form and you can click on each form necessary.  (Just Click On The Form Name to Print), fill them out and bring to our office for your visit.

  Dental History Form: Patient history that we will need for your visit
  Medical History Form: Additional medical history that we need for each patient
  Patient Registration Form: Information we need on each of our patients
  Financial Agreement Form:

Our agreement for payment for services rendered

  No Show Form: Our No Show policy details
  HIPPA Form: Authorization for release of indentifying health information



Cosmetic & Family Dentistry of LaGrange, 214 Parker Drive, LaGrange KY  40031   502-222-2216   Fax: 502-222-2116  
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