patient forms

After making an appointment with Michele Boyne Pediatric Dentistry, we will direct you to this page. Below we have provided links to various forms that must be reviewed and signed by a parent/guardian.

  • The Welcome Form introduces our office and provides general office policies and information.
  • The Receipt of Notice of Privacy Practices gives consent to share the needed information with your insurance company and any consulting physicians/dentists.
  • The Acquaintance Form provides our office with your child's medical history and information regarding the patient's dental insurance.

All three forms will be reviewed by a team member at the first appointment, dental insurance coverage will be verified, and we will answer any additional questions not answered in the information we have provided. This process will take approximately thirty minutes. Upon completion of this necessary "paperwork" your child will begin their dental experience with an examination and any other procedures deemed necessary. The length of the entire first appointment should be approximately one hour.

We look forward to seeing you and your child. You may contact us by phone or e-mail should your questions or concerns require an immediate response.