Patient Forms

patient forms

Help us get to know you!

Please take a moment and fill out our online patient information form. The form is secure and the information you enter is encrypted.

If you prefer, you can also print, fill out and bring in the PDF “Patient Health History Form” below. If you have any questions along the way, feel free to contact our practice.

» Patient Health History Form – PDF*

» Patient Information Form with Privacy Notice – PDF*

*This document is in PDF Format. If you’re unable to open PDF files, you can get Adobe Reader® for free.

Please provide the following information at your first visit:

  • Your referral slip and x-rays from your referring dentist.
  • A list of medications you are currently taking.
  • If you have dental insurance, please bring any forms or insurance cards.
  • Please notify the office if you have a medical condition or concern prior to surgery (e.g. artificial heart valves or joints, heart murmurs requiring premedication, severe diabetes, or hypertension.)
  • Please Note: All patients under 18 must be accompanied by a parent or guardian at the consultation appointment.


Dr Harvey, along with Laura and Lara, his hygienists, are available for patient appointments 8:00a.m. – 5:00p.m. Monday through Thursday, and Dr. Harvey also has some Friday morning appointments. If you have pain or an emergency situation, every attempt will be made to see you that day.

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