New Patient Forms

Thank you for scheduling an appointment with Baylee Dental. 

Click here for online New Patient Forms

If you prefer not to complete your secure forms online, print and bring in all 3 completed forms listed below to your first appointment.

New Patient Registration Form - Please print and bring into the office

New Patient Health History Form - Please print and bring into the office

HIPAA Authorization to Release Health Information to a family member or friend - Please print and bring into the office

Below we have provided all the read only forms to review. 

To assure you will be taken on time, please arrive approximately 15 minutes prior to your reserved time to complete your registration.

  • Our office policy requires identification such as a copy of a Driver's License to be on file for each patient.
  • If you have insurance we will also require a copy of the responsible party’s card to file the claim on your behalf.
  • For further questions regarding x-rays, click on the Radiograph Policy tab at the top of the page.
  • Many of our patients have a PPO Dental Insurance.*  As a courtesy, we will process all claims to be reimbursed directly to you.


Read-Only Forms

HIPAA Notice of Privacy Practices and Electronic Transfer of Personal Health Information - Do not print. Read only.

Office Policy Regarding Confirmations and Radiographs
- Do not print. Read only

Financial Policy - Do not print. Read only.

 


*Baylee Dental is not a participating provider for any insurance company. However, if you have a PPO insurance, as a courtesy to our patients, we will be happy to process the forms for you. Reimbursement is made directly to you in approximately two-three weeks.*

Contact Us.We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form.

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.
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