Mother and daughter sitting in a park holding flowers

Patient Forms

Myers Pediatric Dentistry & Orthodontics

Patient Forms

To continue making your dental experience as pleasant as possible, we have conveniently provided our dental forms below. You can either fill them out through our secure website and submit them to the office of your choice or print the forms and bring them with you to your appointment.

New Patient: Child

Children’s Medical History

Child’s Informed Consent

HIPAA/ Generalized Patient Consent

For New Patients Who Are Still Nursing

Frenectomy

Sleep and Speech

Sleep and Speech Questionnaire

New Patient: Adult

Adult Medical History (seen at our Middleburg office)

HIPAA/Generalized Patient Consent

Records

Transfer of Records