8804 Hawbuck St., Trinity, FL 34655
Phone: 727.478.3210

4156 Woodlands Parkway, Suite A Palm Harbor, FL 34685
Phone: 727.626.2676
Pediatric Dentist

Patient Forms

You may access the following forms to assist us with your care.

ONLINE FORMS: Please complete the Medical History Form one (1) week prior to your appointment. Click the submit button at the bottom. For your convenience, you do not have to print anything.

PRINTABLE FORMS: These forms are for your records only. There is no need to bring them to your appointment unless applicable.

Online Forms

New Patient Letter

Medical History Form - Trinity Office

Medical History Form - Palm Harbor Office

Printable Forms


New Patient Agreement/Consent

The Silent Observer Agreement

Release of Records (MUST GIVE 5 DAYS NOTICE)

Alternate Guardian Consent

Oral Sedation Pre-Op Instructions

Oral Sedation Post-Op Instructions