Completing your paperwork ahead of time keeps your appointment unhurried and focused on your care — whether we are meeting in the Lakewood spa suite or coming to you. Start with the consent form that matches who will be signing, then add the health forms that apply to you.
Everyone starts here. Choose the one that matches who will be signing for care — the patient, or an authorized representative.
Patient intake, scope-of-services consent, teledentistry, radiographs, Silver Diamine Fluoride, HIPAA acknowledgment, communication preferences, and the payment and SuperBill agreement — all in one form.
For patients whose care decisions involve a Medical Durable Power of Attorney agent, court-appointed guardian, or other authorized representative. Covers capacity, authority documentation, in-home and facility service details, clinical consents, and the payment agreement.
Your dental and health history shapes how we plan and pace your hygiene care. The first two are for every patient; the premedication form is only for those who need it.
Your dental history in detail — current concerns, gum and periodontal health, tooth and structural issues, oral comfort, past treatment and trauma, jaw and TMJ function, airway and sleep screening, your daily hygiene routine and product preferences, and the goals you have for your care.
Medical history update covering medications and allergies, cardiovascular and metabolic conditions, airway and sleep screening, nutrition and hydration, dental-material sensitivities, and your own health goals.
Only if a provider has told you to take antibiotics before dental care, or if we have asked for medical clearance. Collects the premedication instruction, antibiotic allergies, and your treating provider's contact details so we can confirm precautions before your visit.
Forms submitted here travel over an encrypted connection and are reviewed only by Sarah Tanner, RDH, BSDH. Clinical records and teledentistry consultations are handled inside Teledentix, our practice-management platform.
If you would rather not send health details through a website, you are always welcome to complete your forms in person or over the phone. Call 720-217-9000 or email sarahrdh@luxurytoothboothinc.com.