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First Time Visit / New Patients

On behalf of the entire Lowcountry Dental Associates and Advanced Dental Center team, we welcome you to our office. Please take a few moments to print and fill out the following forms and bring them to your first appointment with us. We look forward to seeing you soon.

Forms

Form 1: 'Welcome to our Office' (Click on the best format below)
Please print, fill out and bring to our office on your first appointment.

Welcome to our Office.docx (Microsoft Word 2007) or

Welcome to our Office.doc (Microsoft Word 97/2000/XP) or

Welcome to our Office.pdf (Adobe PDF Reader)

Form 2: 'Notice Of Privacy Practices' (Select the best format below)
Please read.

NoticeOfPrivacyPractices.docx (Microsoft Word 2007) or

NoticeOfPrivacyPractices.doc (Microsoft Word 97/2000/XP) or

NoticeOfPrivacyPractices.pdf (Adobe PDF Reader)

Form 3: 'Acknowledgement Of Receipt Of Notice Of Privacy Practices' (Click on the best format below)
Please print, fill out and bring to our office on your first appointment. 
(This states that you have read Form 2 above as required by HIPPA)

AcknowledgementOfRcptOfNoticeOfPrivacyPractices.docx (Microsoft Word 2007) or

AcknowledgementOfRcptOfNoticeOfPrivacyPractices.doc (Microsoft Word 97/2000/XP) or

AcknowledgementOfRcptOfNoticeOfPrivacyPractices.pdf (Adobe PDF Reader)

 

Request Information:

John's Island Office

www.lowcountrysmiles.com

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