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PATIENT FORMS


Our patient forms are available below for download. Please complete the appropriate forms prior to your scheduled procedure and bring them with you on the day of your appointment. Completing your forms in advance helps our anesthesia team prepare for your care and ensures a more efficient check-in experience.

Patient Forms

Save Time Before Your Appointment

For your convenience, our patient forms are available below to download and complete before your scheduled appointment or procedure.

Please download the appropriate form(s), complete all requested information, and bring the completed forms with you on the day of your appointment. Providing accurate and complete information helps our anesthesia team understand your medical history and prepare for your care.

Downloadable Forms

Select the form you need below to download and print:

ADH Medical Evaluation Form

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Common Questions

CONTACT

CONTACT

Inquiries

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment. If you are an existing patient, this contact form should not be utilized for communicating private health information.

Head Office

P.O Box 107

Dix Hills, NY 11746

Tel: (631) 940-3690

Contact Us

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© 2021 by Anesthesia for Dental Health.

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