Medical History Form
This medical history form is required for all patients ages 12 years and older.

Child Health History Form
These child medical history forms are required for all patients ages 11 years and younger.

Patient Information Form
This form is required for each patient and provides basic personal, financial and insurance information.

Payment Policy Form
This form is required for each patient and provides information regarding payment policies at Modern Family Dental, PLLC.

HIPAA Acknowledgement Form
This form is required for each patient which acknowledges and accepts the privacy practices of Modern Family Dental, PLLC. A listing of the actual privacy practices can be viewed or downloaded in the Privacy Practices MFD document below.

Privacy Practices MFD
This document provides a detailed description of the privacy policies and practices at Modern Family Dental, PLLC as required by the HIPAA legislation.