Downloadable forms

If you're planning on visiting our office and have not yet filled out the necessary paperwork, please download, complete and print these forms and bring them along with you.

Notice and Consent

Lehigh Valley Pediatric Dentistry wants you and your child’s visit to be both educational and enjoyable. Therefore, we request that you read this Consent and Notice Form carefully. This form is meant to provide information on some of the routine procedures we perform.

Notice of Privacy Practices (HIPPA)

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information.

Medical History Information

We highly recommend that you print and complete this detailed form out prior to visiting our office.

All forms are provided in Adobe Reader™ format (PDF)