Dansville Family Dental Care

Phone: 585-335-6170

Helpful Forms

Below are links to the forms we will ask you to fill out prior to seeing the doctor. We encourage you to download the forms by clicking on the links below. You can then print the forms from your computer and fill them out in the privacy of your own home prior to visiting our office. Please Note: These forms are .pdf files. If you computer is not equipped with Adobe Acrobat Reader, you will not be able to download these forms. To get a free copy of Adobe Acrobat, please 
click here.

As always, we are here to serve you. If you have an questions, please give us a call.

Right to Privacy Statement (1 page)

Click to download Right to Privacy Statement

Personal Information Form (2 pages)

Click to download Personal Information Form Page 1
Click to download Personal Information Form Page 2

Medical History Form (2 pages)

Click to download Medical History Form Page 1
Click to download Medical History Form Page 2

General Consent Form (1 page)

Click to download General Consent Form

 

Financial and Appointment Policy Form (1 page)

Click to download Financial and Appointment Form

 

 

 

 

Find Us

We look forward to serving you
from our new location:
191 Main St. Dansville NY.
Phone: 585-335-6170

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® Dansville Family Dental Care 2013
191 Main St. Dansville NY 14437
Phone: 585-335-6170