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New Patient Forms

Thank you for choosing Midwest Dental. For your convenience, this section includes forms you'll need during your first visit, as well as what to expect when you come in for your appointment. If you still have any questions about your upcoming visit, please call your Midwest Dental office. We're here to help.

 

Please complete the following information. Be sure to bring these forms to your first appointment. The HIPAA Acknowledgement and Authorization for PHI Disclosure form acknowledges that you have received the form. It also provides instructions to Midwest Dental about who, if anyone, we may disclose information about your treatment.