First Visit Forms
We understand that choosing a dentist is an important decision. After all, your smile is one of your greatest assets and says a lot about your overall health. From the moment you walk in our door, you'll be welcomed by a caring team of professionals in a relaxed, stress-free environment where the whole family can feel at ease.
We look forward to having you as a new patient!
Prior to your first visit, please complete the following forms and submit them to our office as soon as possible.
Patient Registration, Health History and Medication List
Patient Records Release Request Form
HIPAA Authorization Form
Electronic Communications Form
If you would like us to request records, including x-rays, from a previous dental office for you or your family members, please also complete the form below.
Please review the following documents to stay up-to-date on our office policies.
Cancellation Policy - We here at Smiles on Niles feel everyone's time is valuable. We request all cancellations or schedule changes are given with at least 24 hours notice. Last minutes cancellations or failures to show may result in a cancellation fee. Multiple offenses may result in dismissal from the practice.
Patient Privacy - We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice of Patient Privacy about our privacy practices, our legal duties, and your rights concerning your health information.
Being well-prepared for your appointment will ensure that our team has all of the needed information to provide the best possible dental care for you. It also will help relieve any unnecessary anxiety you may be feeling prior to your visit.
We look forward to your first visit.