Office Forms

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" bgproperties="fixed" background="02c285a1erlcgo.png"> <div> <FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>Kendalia Dental Center</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="Kendalia Dental Center"><U><B>home</B></U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="About Us"><U>About Us</U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="Location"><U>Location</U></A>   |   <A HREF="id23.htm" TARGET="_top" TITLE="Insurance Plans"><U>Insurance Plans</U></A>   |   <A HREF="id25.htm" TARGET="_top" TITLE="Fees"><U>Fees</U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="Contact Us"><U>Contact Us</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="Links Page"><U>Links Page</U></A>   |   <A HREF="id22.htm" TARGET="_top" TITLE="Our Mission"><U>Our Mission</U></A>   |   <B>Office Forms</B></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" background="02ad2c00dkelyh.png"> <div> The forms listed to the right are available to download and print for your convenience.</div> <bR> <div> These forms will need to be completed for all new patients.</div> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>Office Forms</I></div> <bR> <div>  <a href="HTMLobj-99/Patient_Information.doc"><u>Patient Information</u> </a>  - Personal and Insurance Information</div> <div>  <a href="HTMLobj-100/Patient_Medical_History.doc"><u>Patient Medical History</u> </a>  - Patient's Medical and Dental History</div> <div>  <a href="HTMLobj-101/KDChipaa_consentform.rtf"><u>HIPAA Consent</u> </a>  - Required by Government Regulations (signature required)</div> <div>  <a href="HTMLobj-102/KDChipaa_privacynotice.rtf"><u>Privacy Notice</u> </a>  - Privacy Policies of the Kendalia Dental Center (read only, no signature)</div> <bR> <bR> <div> The forms are in Microsoft Word format.  It may be necessary to adjust your margins to print.</div> <div> The three forms needed should fit on one page each.</div> <bR> </td> </tr></table></body>