Patient Forms

Patient Forms

New Patient Paperwork

Save time by completing your patient paperwork online! Simply fill in the required fields and submit your forms directly through our secure website. If you prefer, we can conveniently email them to you just as we do for all our new patients. Not sure how to get us your information? We’ve outlined how easy it can be below.

Instructions

To Download

Click the download button and save the file to your folder. Go to the file, click ’Open’ and using Adobe Acrobat, click ’Tools’ and then ’Sign and Fill’. Save the completed form and either print (to bring in with you at your appointment) or return via email as an attachment. Email to: dentist@dentistrichmond.com

To Print

Right click on the file name and select print. You can then complete at your convenience - just remember to bring the form with you to your appointment or fax ahead of time to (804) 897-4032. Don’t worry – that’s a secure fax line that comes directly to our Patient Representatives, so your paperwork doesn’t land on the floor somewhere!

At Your Appointment

If you want us to handle all this for you, we’re happy to do so! We ask all of our patients to arrive 10-15 minutes prior to their scheduled visit, because the Government requires us to have you fill out your HIPAA and PHI information on premises. So, if you need to fill out these forms or make changes to your health history, plan on an additional five minutes or so for this paperwork.

Post-Operative Instructions

At the conclusion of every appointment, our doctors and staff review steps you need to take to ensure your immediate comfort. Please adhere to the instructions you're provided, and should you experience any discomfort, call us immediately! We’ll give you printed instructions for your reference, but you can always jump on our site and quickly find your post-op instructions here. They’re available to download or print for your convenience.

Relax knowing you’re helping the environment. We use HIPAA compliant software to digitally store your Protected Health Information (PHI). In addition, we use Cintas to securely recycle all the paper we generate, saving over 35,000 trees annually!