Accessible Version
Waters Family Dentistry

New Patient Forms

Prior to your first patient visit, we ask you complete several new patient forms. These are available in both English and Spanish. The first form consists of basic contact information, any dental insurance, your dental and medical history. You will also be asked to review and complete a HIPPA (Health Insurance Portability and Accountability Act) document. In this document, you will be asked to identify any individuals to whom you authorize a release your records. This form is reviewed and updated every five years.

There are several ways to access new patient forms. The new patient form is available to download and print below. We are also happy to mail these forms to your home prior to your first appointment. If time does not permit completing the forms in advance, we ask you to arrive 10 minutes prior to your appointment to allow time to complete the forms.

Notice of Privacy Practices

Notice of Privacy Practices (Spanish)

New Patient Form

New Patient Form (Spanish)

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (308) 382-1734
View the ADA Accessibility Statement
COVID-19 Update! Our office has re-opened and is available to serve your dental health needs. We have implemented several protocols as recommended by the Center for Disease Control (CDC) and the American Dental Association. Call us today at (308) 382-1734 to schedule your dental visit.