 Required Forms @ Top of Troy Dental |
Patient Registration Form
This form contains all necessary information about Patient required by your dental office, which includes Name, Social Security#, Date of birth and Dental insurance.
Note: Please print and fill out this form, and bring it with for your next visit.
 Download |
Dental History Form
This form contains a brief questioner about your Dental History. We will keep this form for our records in your file.
Note: Please print and fill out this form, and bring it with for your next visit.
Download |
Health History Form
This form contains a brief questioner about your Health History. We will keep this form for our records in your file.
Note: Please print and fill out this form, and bring it with for your next visit.
Download |
HIPAA Privacy Form #1
This form, Notice of Privacy Practices, containts the information that federal law requires us to provide our patients regarding our privacy practices.
Note: Please print and fill out this form, and bring it with for your next visit.
Download |
HIPAA Privacy Form #2
This form is used to obtain acknowledgement of receipt of our Notice of Privacy Practices or to document our good faith effort to obtain that acknowledgement.
Note: Please print and fill out this form, and bring it with for your next visit.
Download |
Payment Policy
Note: Please print and fill out this form, and bring it with for your next visit.
Download |
