uncommon dentistry for everyday life
Dexter Dental Center - Welcome page Dexter Dental Center
Dexter Dental Center Welcome

For your convience the foms below can be printed, filled out and presented before your visit - please select the appropriate form for the age of the patient.

childsformUnder 18yr Childs Registration Form
Please print, fillout and bring with you when asked to update our records with the information provided

 

 

 

 

 

Registration Form18yr & Older Patient Registration Form

Please print, fillout and bring with you when asked to update our records with the information provided

 

 

 

 

Acknowlodgement of Receipt"This office accepts insurance so I understand that I am responsible for payment of services rendered and also responsible for paying any copayment and deductibles that my insurance does not cover".

Please print, sign and bring with you at your next visit.

 

 

HIPPA Privacy Practices

Notice of Privacy Practices - "HIPAA Compliance"

 

The HIPAA Privacy Rule establishes national standards to protect individuals' medical records and other personal health information and applies to health ...