forms

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Current patients: We require all active patients to update their Health History and acknowledge our most recent privacy notices every 3 years. If informed by our staff that you are due to complete this, please print, complete, and bring both the "HIPAA Update" and "Health History Update" forms to your child's next appointment. For multiple children, please complete a health history form for each child. Only one HIPAA form is required, as you can list multiple children on that document.

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HIPAA Update

Health History Update

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Parents of Kindergarteners/Freshman: Is your child going to be in kindergarten or a freshman this next academic year? If so, the state of Iowa requires all kindergarteners & 9th graders have a dental exam. You can find the form below.

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Kindergarten/Freshman Screening

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Graduating to General Dentistry:  By the teenage years, most kids have reached a point where the expertise of a pediatric dentist is no longer needed. And while we would love to care for our patients indefinitely, there comes a time where adult teeth require an adult dentist. This transition also allows us the opportunity to care for the younger, behaviorally/medically complex children who truly require the expertise and skillset of a pediatric dentist.
 

To make that transition as easy as possible, you can find a copy of local dental providers, as well as a release of records form. 

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Release of Records​

Local Dental Offices

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