82 Ballards Corner Road
PO BOX 592
Hinesburg, VT 05461
Phone: 802-482-3155

Patient Forms

Access Your Forms Here

You may choose to fill out any form either online on your device or by printing out the pdf and sending us a copy via email or fax.

Patient Information Form

PDF

Information on Your Initial Appointment

Your initial appointment will consist of a complete oral examination including an oral cancer screening. Your medical history will be reviewed and an initial evaluation will be made. Usually, treatment recommendations will be made at this time. However, a complex treatment plan may require a separate consultation appointment. This may involve the use of study models (impressions of your teeth), photographs or additional x-rays. We may recommend referral to a specialist or consultation with your physician before a final treatment plan is established.

You can assist us by providing the following information at the time of your appointment:

  • X-rays (if available). These must be requested from your former dentist by you.
  • A list of current medications that you may be taking including dosage and frequency.
  • Dental insurance information including identification and group numbers and any forms or plan descriptions you may have available. This information is necessary to process any claims.
  • If you have a Health Savings Account (HSA) through your business or employer, please let us know the details as these vary from plan to plan.

IMPORTANT: A parent or guardian must accompany all patients under the age of 18 at this initial visit.

Please alert the office if you have a medical condition or any special needs that may be of concern prior to treatment. While our office is handicap accessible, there are medical and physical conditions that may require referral to another care provider.

Ask Us a Question