New Patient Forms
Thank you for choosing Premier Dental of Edgmont Square. We look forward to helping you.
We will need some information about you to get started. To reduce your waiting time during your visit, we have provided these forms that you can complete prior to your appointment.
We encourage you to fill out our online New Patient Registration Form prior to your scheduled appointment.
If you prefer, you may download and print the new patient history forms by using the links below. Please bring the completed forms with you to your appointment.
The purpose of this letter is to request copies of your medical records as allowed by the Health Insurance Portability and Accountability Act (HIPAA) and Department of Health and Human Services regulations.
Consent to Receive Mail, Email and/or Phone Messages
Please complete and bring with you to your next appointment.
The forms are PDF and should open directly in your browser. If not, we provide a link to download Acrobat PDF Reader below: