Patient Registration

On your first visit to our office, we will need a completed patient registration form. To expedite your initial appointment, please complete this form (along with a list of all medications you are currently taking) and bring it with you to our office. It is critical that this form be completed accurately to ensure that Dr. Priest and dental team are aware of all medical conditions prior to treatment. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Please click on the links below to see downloadable Adobe PDF versions of our office forms. You most likely already have this software on your computer. If you have difficulty accessing these forms, please click here to install Acrobat Reader.

Patient Registration Form: This form includes your contact information, health information, dental history, emergency contact information, insurance information as well as our office policies.  

Request for Dental Records: Patients can download this form to authorize the transfer of records/x-rays to Dr. Priests office.

HIPPA Privacy Policy: This form describes our practices regarding the handling of your personal health information in compliance with federal law.

Dr. Referral Slip: Referring Doctors can download our referral slip to provide us with information about the patient and his or her dental condition.

Permission to Use Full Face Images: Dr. Priest is involved in providing continuing education to other dentists. He may request that you provide permission to show your face in pictures presented in clinical presentations. You are not obligated to provide this permission.

Patient Feedback Questionnaire: We would appreciate your constructive feedback on the quality of services you received at our office. You may submit these comments and suggestions anonymously if you prefer.