Patient Forms

Please download and fill in completely the important information on these forms prior to your child’s first visit with us. You may bring the finished paperwork on the day of your visit, email it to info@wallakids.com, or send to our postal address. We are better able to maximize our time with you and your child if we have your information completed prior to your day.
Thank you!

         New Patient Forms
download dental formsPatient’s Confidential Information and Medical History
download dental formsConsent for Dental Care by Non-Parent
download dental formsDental Records Release Form
download dental formsPatient Financial Policy
download dental formsConsent to Use Child’s Photo
download dental formsNotice of Privacy Practices
download dental formsReceipt of Privacy Practices

         Infant Frenectomy Forms
download dental formsFrenectomy Intake Form
download dental formsFrenectomy Consent
download dental formsFrenectomy Post Care
download dental formsPatient Financial Policy
download dental formsReceipt of Privacy Practices
download dental formsNotice of Privacy Practices

Back to New Patients