One of our biggest priorities at Hebron Smiles and Smilebliss Orthodontics is to make dentistry convenient for you. We have made our necessary forms accessible for you to download and print on your home computer so you do not have to spend unnecessary time in our office filling out paperwork.
If you have any questions about your patient forms, please do not hesitate to contact us.
Patient Forms
Patient Consent Forms
- Notice of Privacy Practices
- Change In Med Hx(recall)
- Crown And Bridse Prosthetics
- Consent For Crown Re-cement
- Consent For Denture
- Consent For Extraction Of Teeth
- Composite Fillings
- Consent For Final Cementation
- Consent For Mouthgaurd
- Consent To Perform Endodontics
- Full Artificial Dentures And Partial Dentures
- Informed Consent – Periodontal Treatment
- Credit Card File
- Custom Shade Decline Consent
- X‐ray Refusal Form
- Dental Veneers After Care
- Dentures Post-Operative Instructions
- Medical Clearance For Dental Treatment
- Membership Patient Consent
- Caring For Your Occlusal Guard
- Informed Consent For Nitrous Oxide Sedation
- Consent For Night Guard/Bite Splint
- Ortho Consult
- Orthodontic Deband Consent
- Patient Tx Plan Info
- Post-Op Instructions – Tooth Extraction
- Pre-Operative Sedation/Anesthesia Checklist
- Process To Finish
- Refusals
- Silver Diamine Fluoride Treatment Consent
- Dental Records Release Form
- Pre-operative Instructions For Your Dental Surgery
- Home Care Instructions Following Your Surgery
- COVID-19 Patient Screening Form
Payment Options
Hebron Smiles and Smilebliss Orthodontics is in-network with multiple dental insurance companies. We file claims as a convenience for our clients. We accept cash, check and credit cards.
Our practice offers Care Credit and Lending Club patient financing options and payment plans.
