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HIGH TECH NT DENTAL
OFFICE NOW OPEN!
554 East Robinson St.
North Tonawanda, NY 14120
(716) 695-1137
"Helping Bring our Communities into The Future"
New Patient Forms
Todd R. Levine DDS and his complete staff at Aspire Family Dental® want to WELCOME you to our dental practice. In all of our office's, Modern Dentistry is the rule, not the exception. We are a general dental practice. However, all phases of dentistry are practiced in each of our locations.
We are giving you the option to be able to read and/or read and print a New Patient Packet so you can have it filled out before you come in for your first dental visit with us. We strive to make things more convenient for our patients. If you wish to only read the New Patient Packet on here, please come in 10 minutes earlier to your appointment so you can fill out the New Patient Packet in our office.
This packet contains the following: A. “Advantages of being a patient here” B. “Office policies/Contract” – pages 2-4, C. “Notice of Privacy Practices” – pages 4-6”, D. A space condensed verbatim copy of your “Combined Signature Section” – p. 6, E. Patient Registration – p. 7, F. Medical History – p. 8, G. Actual “Combined Signature Section” – p. 9, H. Authorization For Release of Identifying Health Information – p. 9. A legal document is included which has important information which you must read, understand, and sign your name to.
We are giving you the option to be able to read and/or read and print a New Patient Packet so you can have it filled out before you come in for your first dental visit with us. We strive to make things more convenient for our patients. If you wish to only read the New Patient Packet on here, please come in 10 minutes earlier to your appointment so you can fill out the New Patient Packet in our office.
This packet contains the following: A. “Advantages of being a patient here” B. “Office policies/Contract” – pages 2-4, C. “Notice of Privacy Practices” – pages 4-6”, D. A space condensed verbatim copy of your “Combined Signature Section” – p. 6, E. Patient Registration – p. 7, F. Medical History – p. 8, G. Actual “Combined Signature Section” – p. 9, H. Authorization For Release of Identifying Health Information – p. 9. A legal document is included which has important information which you must read, understand, and sign your name to.
Please choose from one of our locations and the link will bring you to the New Patient Packet for that office:
*NOTE: Please feel free to print only from pages 7-11, we do only need that part of the packet returned to us. We do have copy's of the Office Policies part (pg 1-6) of the New Patient Packet at every location. The Office Policies part of the packet we do send home with you.