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Patient Forms

Please Complete All 7 Forms

We understand filling out paperwork is time consuming.  But completing them in the comfort of your home is better than doing it in the waiting room the day of your visit.  To make your visit to Palm Endodontics easier on you, please complete these health forms prior to your visit.   Begin with the first form by clicking on "Health History" below and then work your way through the following forms one by one.   After completing each form, it should lead you to the next form automatically.   All forms are HIPAA compliant for privacy of medical records. 

You must complete all 7 forms to be finished.

Start Here

FORM  1

Health History

FORM  5

Authorization of Release for Medical-Dental Records

FORM  2

Informed Consent for CBCT Scans

FORM  6

Financial Policy

FORM  3

Informed Consent for Root Canal Treatment

FORM  7

Protected Health Information Release

FORM  4

Informed Consent for Endodontic Surgery
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