Welcome to Edalat Dental Arts!

Welcome to
Edalat Dental Arts!

We are excited to welcome you to our practice, where your comfort,
well-being, and health are our top priorities. To help ensure that
your visit is as seamless and efficient as possible, we ask that you
complete the necessary forms before your appointment. This will
allow us to provide you with the best care tailored to your needs.

You can easily complete and submit your forms online, or if you
prefer, print them out, fill them in, and bring them with you to your
appointment. Submitting your forms ahead of time helps minimize
waiting and ensures we have all the necessary information to offer
you a smooth and personalized experience.

Required Forms:

Patient Registration Form

Share your personal details and contact information so we can set up your account and prepare for your visit.

Download PDF

Patient Medical History Form

Help us understand your medical background, current medications, and any conditions that may affect your treatment plan.

Download PDF

Patient Insurance Form

Provide details of your dental insurance coverage, ensuring that your billing is accurate and seamless.

Download PDF

HIPAA Privacy Form

We are committed to protecting your personal health information. This form ensures we comply with privacy regulations.

Download PDF

For Referring
Physicians

If you're a physician referring a patient to our practice, please submit
the Referral Form to help us address your patient’s needs promptly
and efficiently.

How to Submit Your Forms:

Online Submission

Online Submission

Fill out the forms directly on our
website and submit them securely
to our office.

Print & Bring

Print & Bring

Prefer a paper copy? Simply download
the forms, complete them, and bring
them with you to your appointment.

We appreciate your cooperation and look forward to providing you with exceptional care in a welcoming
and comfortable environment.