Patient Forms

Introduction

We value new patients and welcome you to our practice. To become established as a patient, there are several forms that you must complete. By clicking the Patient Information Form link below, you can fill out the necessary forms online from the comfort of your own home.

General Information form allow us to know how to contact you.
Insurance Information form helps us to file your insurance for you.
Medical Information and Medical History forms are necessary to help us provide the best quality care without unnecessary compromises to your health.
HIPAA form is required by law and is designed to help protect your privacy.
Financial Policy form provides information about our payment and insurance policies.
Authorization to Release Dental Records form allows us to obtain your dental records from your previous or current dentist.

Patient Information Form

After obtaining an appointment, please visit the following link to fill out new patient information:

Patient Information Form

Request An Appointment

Schedule your appointment with Dr. Clark Brown at Implant Dentistry of Florida.

We know your time is valuable, so we've made scheduling an appointment at our dental office easy. Just fill out the form below and we’ll contact you to confirm a time that’s perfect for your schedule.
Name*
Email
Phone*
Preferred Date*
Date Format: MM slash DD slash YYYY
Preferred Time

: HH

MM
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* All indicated fields must be completed.
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Patient Forms

Introduction

Patient Information Form

Patient Information Form

Request An Appointment

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