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Patient Forms

Are you visiting one of our Central Texas dental offices in Belton, Harker Heights, Killeen, Taylor, Temple, or Waco for the first time? We look forward to welcoming you to our extended family.

To make your first visit more convenient, we’ve made our new patient forms available here on our website for you to download. We invite you to complete them before arrival, so we can begin processing them as soon as you come in.

If you have any trouble downloading or opening our forms, let us know and we can fax or mail them to you instead.

Download Our Forms

We’ve made our forms available online to help you skip the time in our waiting rooms! Please complete all the necessary paperwork prior to your first visit by downloading and printing each document below.

We’ve separated our forms for English- and Spanish-speaking patients, in addition to segmenting them depending on your dental coverage.

Important note: Please make sure to complete the correct forms based on your benefits coverage (PPO insurance, Medicaid/CHIP) and age of the patient. If you have any questions, don’t hesitate to contact one of our central Texas Belton or Taylor offices to confirm which forms are right for you.

ENGLISH FORMS

NEW PATIENTS (PPO INSURANCE, ALL AGES)

CHIP & Medicaid (Under 3 Years Old)

CHIP & Medicaid (3 to 6 Years Old)

CHIP & Medicaid (6 to 18 Years Old) 

FORMAS EN ESPAÑOL

Nuevos Pacientes (PPO Seguros, Todas Edades) 

CHIP y Medicaid (Menores de 3 Años)

CHIP y Medicaid (3-6 Años)

CHIP y Medicaid (6-18 Años)