New Patient Registration Forms
Please feel free to download and fill out these forms prior to your first appointment. This will help us to better serve you when you arrive!*after printing the form hit back on your browser to return to our site*
Financial Policy Letter
HIPAA Consent Form
HIPPA Acknowledgement Form
HIPAA notice of Privacy Practices
Insurance Information Letter
New Patient History
Signature on File
Lernor Family Dental * 4747 E Bell Road Suite 7 * Phoenix, AZ * USA * 85032Phone: (602) 485-4747 Fax: (602) 485-0123
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