Patient Forms

Please print and fill out the form(s) below pertaining to your child’s appointment.

For a fillable PDF option, please download, fill out the applicable sections, save, and email back to us at scheduling@westmetrokidsdental.com.

NEW Patient Forms

New Patient Parent Letter
New Patient Form (fillable option)
Privacy Policy
Appointment & Financial Policies
Acknowledgement Sheet (fillable option)

EXISTING Patient Forms

Health Update
Temporary Consent Form (fillable option)
Health Update-Emergency (fillable option)
Records Release Form

OPERATIVE Treatment Forms

Restorative Treatment Introduction
Treatment Consent Form
Nitrous Oxide Consent Form
At Home Care Instructions