Patient Forms

For your convenience, we have provided access to our patient forms below. You can download and fill out your forms at your own pace and in the privacy of your own home or office. By completing your forms prior to your visit, you will have more time with our dentists planning your treatments and creating your new smile.

Online Forms

Authorization for Disclosure
Hipaa Privacy
Patient Health History 2020
12 & older

Pediatric Dentistry Health History
11 & younger

Release of Records 2020

Print Forms

Authorization for Disclosure
DentalCom Coverage
Hipaa Privacy
NOTICE OF PRIVACY PRACTICES
Patient Health History 2020
12 & older

Pediatric Dentistry Health History
11 & younger

Release of Records 2020

If you need help with your paperwork or if you would like to schedule your dental appointment in Marshfield, Stratford and Neillsville, Wisconsin, please feel free to contact Dental Clinic of Marshfield.