Forms

Expedite and simplify your visit to our office by printing and filling out the forms below before you come in. Including registration forms, release forms, consent forms, and financial agreements, having these on hand at the time of your appointment will save you time in the waiting room and make every visit a breeze. If you have any questions or concerns related to the forms below, please do not hesitate to contact us. Click the links below to download each form as needed.

Registration Forms

First time making an appointment with Penn Avenue Family Dental? Fill out the form below to complete your registration as a new patient. So glad that you are joining our community!

ONLINE REGISTRATION FORM

Release Form

This form grants us access to your important dental records and information from another dentist or dental specialist, allowing us to provide you with the best possible care.

RECORDS RELEASE FORM

Covid Questionnaire

Although the world is transitioning back to normalcy, we do ask that you fill out this form before a visit to ensure the safety of our patients and staff.

Do you have fever or you felt hot or feverish recently? (14-21 days)
Are you having shortness of breath or other dificulties breathing?
Do you have a cough?
Any other flu-like symptoms such as gastrointestinal upset, headache, or fatigue?
Have you experienced recent loss of taste or smell?
Are you in contact with confirmed covid-19 positive patients?
Is your age over 60?
Do you have heart disease, lung disease, kidney disease, diabetes, or any auto-immune disorders?
Have you received a covid vaccine?