For your convenience, please click on the button below to complete and submit the patient forms online before your visit. If you are unable to complete the form online, please arrive 15 minutes early for your appointment so that you can complete it in our office.
Please have the following information available when completing the form:
- Your dental and medical insurance cards (you may upload a digital copy of the card at the end of the form)
- A list of your current medications
- The names and phone numbers of your dentist, orthodontist (if applicable) and your medical doctor
- The name, address and phone number of any individuals you would like us to share your records with (i.e., significant other, parent, or friend)
If you have records from a previous office that you would like to have sent to our office, you may click the link below to download a form, which you may use to request the records. Once the form is completed, please return it to the office that will be sending us your records.
Records Request Form
If you would like us to share your records from our office with another individual, please click the link below to download a form. Once completed, please return the form to our office via fax 1-855-915-1519 or email, Lila@CASoralsurgery.com.
Consent for Use and Disclosure Form