Patient Forms at Lincoln Dentist

We want to make things easy for you when you arrive, so we have provided a few of our forms online that you can print, fill out, and have ready when you visit. The forms are in Adobe Acrobat format. If you do not have Adobe Acrobat installed, please click on the "Get Adobe Reader" icon to the right and it will begin downloading. This is a free program and does not send any user information to us or Adobe.

HIPPA - Patient Consent Form

Lincoln Dentist does not share your information with anybody without your consent. In fact, we won't even share your information with your insurance company or other medical professionals without first obtaining written permission to do so. This form is required by Federal law and must be completed prior to service. Please click on the image to the left to print the patient consent form. If you have any questions about this form please feel free to call us at 916-632-8511 or send us a question using this form.

New Patient / Medical History Form

We want to provide you with the best dental care anywhere. Part of our job is learning about your past dental and medical history to insure we choose the appropriate treatments for you. This new patient form helps us learn about you and your specific needs. We ask all new patients to complete this form at home or in our office prior to treatment. Dr Smurthwaite will discuss this form with you and address any special needs you have during your initial consultation. If you have any questions about this form, please call us at 916-632-8511 or send us a question using this form.