Drs. Love and Miller request that all new patients complete the following Forms prior to or at their first appointment. You may also be asked as an existing patient to complete some of these forms prior to your visit if we need to update any of your information, for instance your medical history or insurance details. 

If you would like to complete these forms prior to coming in to our office, we encourage you to do so. This may be a particularly good idea if you require extra time to provide the information requested, for instance current prescriptions, or other financial or insurance-related issues.   

Please don't hesitate to contact our staff if you have questions, or need further information. We look forward to seeing you soon.

Drs. Love and Miller

FORMS: Please click on the links below for immediate download.                            

Patient Registration (Side 1) and Consent for Treatment (Side 2)                           

Statement of Privacy Practices (Side 1) and Acknowledgement of Receipt of Notice of Privacy Practices (Side 2)

Statement of Office Policy (Side 1) and Insurance Information (Side 2)

Medical History for patients age 12 and older (Side 1) and Dental History for patients age 12 and older (Side 2)

Your Child's Medical History for patients 11 and under (Side 1) and Your Child's Dental History and Habits for patients 11 and under (Side 2)

Click here to download ALL forms in one file. (Approximate size = 1.8 MB)