Patient Forms |
For
your convenience, we have supplied our patient registration forms in two
formats.
The Health Insurance Privacy and Portability Act (HIPAA)
is a federal law designed to protect your personal health information.
Robert J. Morris DMD is HIPAA compliant. For your
convenience, we have provided a printable version of our HIPAA Notice of Privacy
Practices and Acknowledgement forms.
For new patients, please print, sign and
bring the Acknowledgement form to your first visit.
Simply click on one of the links below to choose between the printable pdf version or
the online patient registration version. Please call our office if you have any
questions.
Need the Adobe reader?
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NEW PATIENT OFFER
$100 OFF Teeth Whitening
(Includes molds, bleaching trays, and 2 kits of bleach)
Would you like to receive$100.00 or more credit on your account? Please refer your friends and neighbors and we will apply $100.00 to your account for the first referral and$50.00 thereafter for every referral who completes a new patient exam and cleaning. |
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