Patient Forms

At Hamburg Family Dental, we strive to make every experience here pleasant and informative. Our team is ready to answer any questions you have about our dental procedures and pricing in order to make the most out of your appointment and stay vigilant about your tooth care.

You can read up on our privacy and medical policies below, and we’ve also uploaded forms for you to fill out and bring to your next appointment in order to speed up the check-in process. If you need help filling out any of these forms, or have questions about any of our policies and medical plans, please get in touch with us by calling 610-562-7348.

Record Release.pdf
Adobe Acrobat document [297.3 KB]

Adult Medical History
Download, Print Out, Fill Out, and Bring In to your Appointment!
Adult Med History.pdf
Adobe Acrobat document [496.7 KB]

Child's Medical History
Download, Print Out, Fill Out, and Bring In to your Appointment!
Child's Med History.pdf
Adobe Acrobat document [97.7 KB]

Patient Privacy Notice
This form does not need to be printed, but feel free to read over prior to signing the acknowledgement.
Patient Privacy Notice.pdf
Adobe Acrobat document [100.5 KB]

Patient Privacy Acknowledgement
Download, Print Out, Fill Out, and Bring In to your Appointment!
HIPAA-consent NEW.pdf
Adobe Acrobat document [158.6 KB]

Patient Financial & Insurance Agreement
Download, Fill Out, & Bring in to your Appointment!
Patient Financial and Insurance Agreemen[...]
Adobe Acrobat document [62.8 KB]