Resource Library

Patient Forms

New Patient Packet

A comprehensive new patient intake packet covering registration, contact permissions, health history, dental history, financial policy acknowledgment, and privacy acknowledgment.

Best used for

Where this helps inside the clinic.

New patient intake

Paperless intake planning

Practice onboarding

Resource structure

What the resource should help your team capture.

Patient Registration

Identify the patient and preferred contact method.

Legal name
Preferred name
Date of birth
Address
Phone
Email
Emergency contact

Responsible Party

Clarify billing and consent authority where relevant.

Responsible party name
Relationship
Billing address
Phone
Email
Signature

Insurance and Payment

Collect coverage and payment responsibility information.

Insurance provider
Member ID
Group number
Policy holder
Secondary insurance
Payment policy acknowledgment

Communication Consent

Capture permission for appointment and account communication.

SMS consent
Email consent
Voicemail consent
WhatsApp consent if used
Marketing consent if applicable

Privacy and Signature

Document privacy acknowledgment and patient certification.

Privacy notice received
Information is accurate
Patient or guardian signature
Date

The Practice Presence for Dental Clinics

Want the finished version for your clinic?

Request this resource and include what your clinic needs it to solve. We use that context to tailor finished packs around real operational problems.

Request this resource