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East Avenue Dentistry PLLC
Great Experience. Great Smile!

Patient Forms

Patient Forms

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

Adult Patient Forms (complete #1-3 and bring with you)

  1. New Patient Registration (required)
  2. Adult Medical History (required)
  3. Acknowledgment of Receipt of Notice of Privacy Practices (required)
  4. Notice of Privacy Practices (please read, print for your records only)


Child Patient Forms (complete #1-3 and bring with you)

  1. New Patient Registration (required)
  2. Child Medical History (required)
  3. Acknowledgment of Receipt of Notice of Privacy Practices (required)
  4. Notice of Privacy Practices (please read, print for your records only)


Testimonials

"All the doctors give you their full attention when discussing your treatment plan. Their eye contact makes me feel like I have their complete attention."

Rachel C.

Laura P. posted on East Avenue Dentistry's Wall.

Laura wrote:
"2 weeks ago I called the office at 4pm just to get some information. By 5:15 I
had a consultation, xrays, and an appointment for 3 weeks later. Called the
following monday to move it back a week and the response was "no problem"! I
have had so much painful dental work done and needed so much that I was VERY
nervous. The staff was fantastic, my nurse was amazing and Dr. Rosen worked
magic! 12 cavities filled and drilled, 2 extractions and thank to conscious
sedation and their gentle touch I felt NOTHING!!!! I have a completely healthy
mouth for the first time in 15 years! Thank you!!!!!!"

Laura P.

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