We have streamlined our forms to include procuring your insurance information and permission to treat your child. Accurate medical information is very important to provide excellent care of your child. Also, we are happy to submit your insurance claim, but need your help in completely filling in the required information.
Dr Evangelisti and her staff would like to learn about your child’s habits and diet in order to help your child have optimum dental health. The information you share with us helps us know what tools, tips, and advice we might share with you to give your child the best start to keeping his/her teeth healthy for a lifetime! Habits start early and are very hard to break later. So let us help you give your child good habits!
Dental Health History
Dr Evangelisti and her staff would like to learn about your child’s habits and diet.
Medical History form
We have streamlined our form to include procuring your insurance information and permission to treat your child.
Notice of Privacy
Please take time to review this notice and sign the HIPPA form bellow. If you have any question, please contact us.