During your first visit to Augusta Family Dentistry, a Patient Care Coordinator will assist you in the completion of required forms. In order to make the process even more simple, you may print out the forms that we will be completing with you by selecting the forms listed below. All patient forms on this website may be completed before your appointment. However, all forms must be signed by you, the patient, while you are at Augusta Family Dentistry with one of our Patient Care Coordinators.
Current patients at Augusta Family Dentistry will not need to complete the following forms at each visit. However, we will review and complete these forms with you once per year to keep our records current and to keep you informed of our policies. Current patients should also inform us of any changes in their billing information, address or dental insurance when they visit us for their next appointment.
Patient Information
Please feel free to print and complete this form before your visit with us. However, all forms must be signed at Augusta Family Dentistry in the presence of one of our Patient Care Coordinators.
Patient Information - Page 2
Please feel free to print and complete this form before your visit with us. However, all forms must be signed at Augusta Family Dentistry in the presence of one of our Patient Care Coordinators.
General Consent for the Use of Local Anesthetic
Please feel free to print and complete this form before your visit with us. However, all forms must be signed at Augusta Family Dentistry in the presence of one of our Patient Care Coordinators.
Notice of Privacy Practices
Please feel free to print and complete this form before your visit with us. However, all forms must be signed at Augusta Family Dentistry in the presence of one of our Patient Care Coordinators.
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P: 316.775.2482 F: 316.775.5068
401 State Street Augusta, KS 67010
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