Patient Forms


Below, you will find all of the forms needed for your child’s initial visit. Please complete all forms, don’t forget to bring their Dental Insurance Card to the appointment.

Note: If bringing multiple children in for their initial visit, please complete a New Patient Registration form for each child.

New Patient Form
We are always welcoming new patients to our practice. If you have already scheduled your child’s new patient exam and need to provide us with your child’s information. The forms are protected by SSL encryption and all submitted information is confidential

Office Referral
On behalf of all our team, we would like to thank you for trusting us with your patients. We appreciate the partnership that has developed between our offices and look forward to working with you to provide the very best care for our patients. You may refer patients to our offices by filling out our secure online Referral Form.

Guardian Consent
Please complete and bring this form if your child will be attending his/her dental visit at Little House of Smiles, Children’s Dentistry with someone other than a parent/legal guardian. Use a separate form for each child.