Please submit each form individually.

*Also, please note that if you are using the ’Submit by Email’ button, once you pick the option “Desktop Email Application”, an email will be sent automatically via your email client. Confirm each form has been sent individually by checking your sent box.

Patient Registration Form

Patient Dental History Form

Patient Medical History Form

Consent Form

Photo release agreement

Acknowledgement of Receipt of Privacy

* If you are having problems with filling out the forms in the browser please click below to download the Patient Forms to your computer. Then please email or fax them to 404-262-1023.

Patient Forms Zip File