Patient Forms

Please complete the following before your appointment.

First download the form, fill-out the interactive fields and then attach the forms below in an email back to: sally@sallypowelldds.com
Alternatively, you may print, fill-out and bring them with you to your appointment.

1. Patient History (if filling out for a minor or child, please use this form: Child Patient History)
2. Financial Policies
3. Read the HIPAA Privacy form and fill-out the HIPAA Acknowledgement
4. Limited Dental Warranty is an explanation of what services we guarantee to repair or replace if necessary (no need to fill-out).

If you would like to authorize the release of your dental records, please complete the following form: Records Release Request