Consent, Medical History, & Other Forms for Patients

  • Please be sure to scroll down on all forms; and 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.
  • We will begin sending texts very soon but have not yet; if your appointment is within a month, you may not receive a text even if you select that as your preferred contact method.
Smilies Pediatric Dentistry
Patient Authorization to Consent for Treatment
Medical History Forms
Patient Information Form (Please Complete with History)
Contact Information Update Form
Preferred Contact Method Form
Smilies Pediatric Dentistry