Patient Information & Forms
My entire staff and I welcome you to Liberatore Family Dental, your new Oral Wellness Center. We will support your long term dental needs in a prompt professional manner with a focus on quality preventive care while providing comprehensive restorative therapies.

My staff and I look forward to seeing you at your first visit. We will customize your first visit to your individual oral health requirements. Of utmost importance is a comprehensive medical history review.

For your convenience we have included the required forms in PDF format for you to fill out before your first visit. Please print out the forms, complete them to the best of your ability and bring them to your first appointment. Our staff will review the forms with you at that time.

Note: Adobe Acrobat Reader is required to view and print the forms. You can download and install the free Adobe Acrobat Reader by clicking on the link below.



Patient Registration Form

Medical History Form

HIPAA Form

Records Release Authorization



 
 

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