• 6132 W. Creek Rd, Independence, OH 44131
  • (216) 524-8481
  • Contact Us
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  • OUR SERVICES
  • FORMS
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  • CONTACT
  • BLOG
  • PAYMENT FORM
  • HOME
  • ABOUT US
    • Our History
    • Hygiene Department
    • Clinical Department
    • Administrative Department
    • Patient Education
    • FAQ
  • OUR SERVICES
  • FORMS
  • INSURANCE/FINANCIAL
  • CONTACT
  • BLOG
  • PAYMENT FORM

Forms

  • Home
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  • Forms

New Patient – Adult Forms

Adult Welcome Letter

Adult Health History Form

Financial Policy Form

Release of Records Form

HIPAA Acknowledgement Form

 

OMNIBUS Rule Privacy Policy

New Patient – Child Forms

Child Welcome Letter 

Child Health History Form 

Financial Policy Form

Release of Records Form

HIPAA Acknowledgement Form

Make An Appointment

Our Office Hours Are:

Monday - Thursday:  7:30 am - 8:30 pm

Friday:  7:30 am - 1:30 pm

Saturday:  *8:00 am - 1:00 pm

Sunday:  Closed

*selected Saturdays - please call to confirm
  • (216) 524-8481
  • 6132 West Creek Road, Independence, OH 44131
  • Contact Us

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