New Patient Forms
Thank you for choosing Midwest Dental. For your convenience, this section includes forms you'll need during your first visit, as well as what to expect when you come in for your appointment. If you still have any questions about your upcoming visit, please call your Midwest Dental office. We're here to help.
Please complete the following information. Be sure to bring these forms to your first appointment. The HIPAA Acknowledgement and Authorization for PHI Disclosure form acknowledges that you have received the form. It also provides instructions to Midwest Dental about who, if anyone, we may disclose information about your treatment.
For Your Information
Please take a moment to read these important notices prior to your appointment. We will provide a copy of our privacy practices to you at your appointment, or you may view them below.
Midwest Dental Financial Policy
Please read, agree to, and sign our financial policy prior to any treatment.Download Form
Patients with certain medical conditions may need to take medication before seeing the dentist.Download Form
Day of Your Appointment
Please arrive 15 minutes before your scheduled appointment. This will allow us to finish any paperwork and stay on schedule with your appointment. Please bring the following items with you to your first appointment: