For your convenience, Pediatric TLC new patient forms are available here in PDF format so you can print them out and complete them at home. We especially encourage parents of new patients to complete the Patient Information form prior to your first office visit so that we may serve you more efficiently and minimize your wait time.
Just click the links below to download and print any form.
- Patient Information
- Acknowledgement and Consent
- Authorization to Disclose Protected Health Information
- Budget Agreement
- Consent Form
- Cuestionario del Historial Oral
- Notice of Privacy Practices
- Oral Health History
- Professional Provider Patient Disclaimer
- Re-establish Care Agreement
- Temporary Waiver – Copayment