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Forms

We have prepared for you the most frequently needed forms and documentation in a downloadable format, Adobe PDF (Acrobat).

To download a document just click on it's link:

Little Smiles Policies
Patient Registration Form
Privacy Practices (HIPPA)
Recall Form
Medical History Update Form
Records Release Form
Parental Substitute Consent Form

Acknowledgement of Receipt of Privacy Practices


Sedation Information
Pre-Sedation Instructions
Post-Sedation Instructions
Consent for Sedation Form
Consent for Nitrous Oxide/Oxygen Use

Post-Extraction Instructions
Stainless Steel Crown Infromation
Space Maintainers Information

Pediatric Dentistry Indiana Dentist.

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