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NEW PATIENT FORMS

HIPAA FORMS

New Patient Info

Notice of Privacy Practice

Insurance Information

Acknowledgement of Receipt

Medical and Dental Info

Consent for Release of Personal Health Information

 

Medical History Update

 

Financial Policy

 

 

 
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Dr. William Smith is a dentist providing dental procedures such as cleanings, dental crowns, teeth whitening,
dental implants, and porcelain veneers in Pompano Beach. Dr. William Smith is licensed as a general dentist in the state of Florida.

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Florida Dental Care Group
3170 North Federal Hwy. • Pompano Beach, FL 33064
Phone: 888.956.1010 • Email: info@floridadentalcaregroup.com