Forms

1. New Patient Forms

Please have these forms filled out & e-mailed to us prior to to your appointment.

e-mail: DF.FamilyDental@gmail.com

Thank You,

DFFD Team

medhistform-copy

Request & Consent for Dental Treatment

Patient Consent Form

Emergency Contact

Insurance Responsibility

Request for Release of Dental Records

 

2. COVID-19 Patient Pre-Screening

Our patient’s safety & health is important to us at Dobbs Ferry Family Dental. To prepare for your visit during this pandemic, we ask you to answer the following questions. 

Upon arrival at our office, we kindly ask you to telephone our front desk for instructions as to when you can enter the office. Our staff will review the following form prior to your arrival into the office. 

Also, please note that if you require assistance, you can only be accompanied by only one person. You must wear a mask upon your arrival and immediately after entering the office, you must use hand sanitizes conveniently located at the front desk.

Find COVID-19 Pre-Screening Form below.

COVID-19 Pre-Screening