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Forms

Forest Hill Dental Forms

Forest Hill Dental provides our patients with a downloadable print version or our simple easy to fill out confidential online version. Please select the form in which you would like to submit.

Health History Form

Health History Form

Online Version of Health History Form Printable PDF of Health History Form
Transfer of Records

Transfer of Records

Online Version of Transfer of Records Printable PDF of Transfer of Records
Privacy Act Form

Privacy Act Form

Online Version of Privacy Act Form Printable PDF of Privacy Act Form

Transfer of Records

Dental Office

Phone (XXX-XXX-XXXX)

Fax (XXX-XXX-XXXX)

I, request and authorize Dr. to transfer my dental records to Forest Hill Dental.

Please Include The Following (If Available)

Radiographs taken within the last 3 years
Treatment notes (especially any major work that has been completed)

Last Comprehensive Oral Exam

Last Check-up Ex rays

Last Panoramic Radiograph

Last Recall Exam