Consent, Medical History, & Other Forms for Patients

  • Please be sure to scroll down on all forms, many have more than one page.
  • Do not use a cellular device if you are filling out a web form, as the form may not be processed. Please use a desktop or laptop.
  • Parents can choose to receive text reminders. A text message will be sent to the number provided, reply “OPTIN”
  • To fill out our forms, click on the links below. Please answer each question, type NA if there is no answer applicable. Once each section is completed, select “Submit.” You may get an "ERROR" message once you submit the paperwork. This is a technical glitch dealing with the web browser that is used. We have found that the forms usually get through even though the message appears. You are welcome to call the office to ensure we have received the forms.
Smilies Pediatric Dentistry
Smilies Pediatric Dentistry