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 prior to your 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 - 

For patients transferring to our office, please fill out this form so we can obtain your records from your previous office 

Consent to Treat Minor -

For patients who are coming under the age of 18 without a parent/guardian present. Please have parent/guardian complete prior to arrival.

New Patient- Adult (please fill out all forms in this category)

Adult Health History - 

For patients age 14 and older 

Insurance & Financial Agreement

Hipaa Consent- Please list anyone you would like to have access to your information

Record Release- This form will help us to obtain records from your previous office so we can better serve you.

New Patient- Children (under age 18, please fill out all forms in this category)

Children's Health History - 

For patients under 14

Hipaa Consent- Please list any family members that are allowed to have access to your child's information

Insurance & Financial Agreement

Record Release- This form will help us to obtain records from your previous office so we can better serve you

Children's Sleep Screening - 

For patients under 18