Call: (281) 350-6677
Patient Forms

New Patients


Please bring a copy of your insurance card and driver's license with you to your first appointment and subsequent appointments.  

Also, a current list of all your medications, past medical problems, hospitalizations, and past surgeries is required to be documented and discussed with my patients before any treatment is initiated. 

If you choose to expedite your paperwork, you can download and fill out our required forms from this page.  Please complete and bring the first (5) forms only.  The last one is for "read"only regarding our office's privacy practices.

These completed forms, with front and back copies of your insurance card, may be faxed to us, or scanned and emailed to:


Form 1         Dental History

Form 2         Patient Information Form  

Form 3         Medical History   (bring complete list of medications with correct spellings and dosage)

Form 4         Privacy Form    

Form 5                Disclosure Authorization0001.pdf     


READ ONLY  Notice of Privacy Practices   (read this document prior to signing Privacy Form above)