Patient Forms
 New Patient PaperworkPlease complete our Online paperwork BEFORE your visit. If your computer cannot read or print the document, please come 30 minutes prior to your appointment, or feel free to come by our office to pick up hard copies of the paperwork to fill out. The appointment time we have set for your child does not take into account time to fill out the paperwork. Records Release Form Are you moving? Need copies of your records or x-rays? Please fill out the following form and give us a call so that we can have them ready for you upon your arrival. Copies of records other than for purposes of referral to another doctor or dentist incur a $10 processing fee per child. HIPPA Privacy Policy Most of us feel that our health and medical information is private and should be protected, and we want to know who has this information. Now, Federal law gives you rights over your health information and sets rules and limits on who can look at and receive your health information. Alternate Adult Representation Will you be having another adult bring your child(ren) to thier dental appointments? If so, we need proper permission! Please print and fill out the form at the link below as well as the credit card authorization if needed. For any questions, please ask our front desk representatives. IV Sedation Forms
Ashburn Children's Dentistry works with Olympic Anesthesia for IV Sedation services. You can find their paperwork for review online at the link below. For any questions, please ask our Insurance Coordinators or Olympic Anesthesia. You can contact them at the phone numbers and email address listed on their forms.
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