Below, you will find all of the forms needed for your child’s initial visit. Please complete all forms, and submit prior to your child’s first appointment with us at the The Brush Stop Pediatric Dentistry and Orthodontics. NOTE: signatures will be captured in the office. Each form will require the first and last name of your child as well as date of birth in order to submit. This can be found in the upper left hand corner.

Note: If bringing multiple children we will need individual forms for each child, however it is not necessary to fill out the insurance registration form multiple times..

Please find the following forms to complete prior to your first visit. Signatures will be captured upon arrival in office:

NEW PATIENT REGISTRATION FORMS

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