For new patients
Chandler Dentist Forms
We know how annoying it is to sit in the office and fill out forms, only to realize you forgot a crucial piece of information. That's why we provide these forms online — fill them out in the comfort of your own home and get in to see the dentist faster.
Prefer to do it online?
When you book through our scheduler, you can complete your intake digitally — no printing required. Takes about 5 minutes on your phone.
Book Online & Complete IntakePrint & bring in these forms
If you'd rather fill out paper forms, download and print these ahead of your appointment. Bring the completed pages with you on your first visit.
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PDF
Patient InformationContact, insurance, and emergency-contact details.
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PDF
Health HistoryMedical history, medications, and allergies.
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PDF
Consent Form (Page 1 of 2)Treatment consent — page 1.
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PDF
Consent Form (Page 2 of 2)Treatment consent — page 2.
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PDF
HIPAA Privacy Notice (Page 1 of 2)Notice of Privacy Practices — page 1.
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PDF
HIPAA Privacy Notice (Page 2 of 2)Notice of Privacy Practices — page 2.
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PDF
Insurance StatementAssignment of benefits and payment responsibility.
Questions about the forms? Call or text 480-840-1101 — we'll help you figure out which ones apply.
Ready to book your visit?
New patients get our $89 first-visit special — exam, digital X-rays, and cleaning for no-gum-disease patients.