Patient Forms

To fill out and submit a form, please download and fill out by hand and either mail or fax the form to our office. You can also fill these forms digitally via Adobe Acrobat (available here).

Bellefontefamilydentistry Patientlogin

Patient Login

Patient Login

Existing patient portal login

Existing Patient Login
Bellefontefamilydentistry Newpatient

New Patient Registration

New Patient Registration

New patient portal login

New Patient Portal
Bellefontefamilydentistry Allforms

ALL Forms Download

ALL Forms Download

Download all forms at once

Download PDF
Bellefontefamilydentistry Financialoptions

Financial Arrangments

Financial Arrangments

Financial Agreement Form

Download PDF
Bellefontefamilydentistry Medicalrelease

Records Release

Records Release

Records release form

Download PDF
Bellefontefamilydentistry Medicalhistory

HIPPA Release

HIPPA Release

HIPPA notice of privacy

Download PDF
Bellefontefamilydentistry Qualitydentalplan

Quality Dental Plan

Quality Dental Plan

Download PDF
Bellefontefamilydentistry Sedationhistory

Sedation Patients

Sedation Patients

Download PDF