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.

New Patient Registration Form
Please complete and print this form and bring with you to the first visit for each new patient.

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.

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.