Patient Forms

Don't want to spend office time filling out paperwork before your dental appointment? These forms can be completed before your visit to Wetherill Family Dentistry, for your ease and convenience.
Schedule Appointment
Young Blonde Woman Standing Beside Window

Printable Patient Forms

The patient forms below can be printed and completed before your visit to Wetherill Family Dentistry. Doing so in advance will help to streamline your initial visit, and will ensure that Dr. Wetherill is informed of your comprehensive medical history.

When you share your medical history with Dr. Wetherill and his staff, please be sure to provide complete, up-to-date information on your health. Inform them if you have experienced recent hospitalization or surgery, or if you have recently been ill. Please be sure to notify Dr. Wetherill if you have had any joint replacements. Also tell Dr. Wetherill the names, doses, and frequency of any medications you are taking – whether prescription or over-the-counter products — and the name of your primary physician. This information will help Dr. Wetherill and his staff to select the most safe and effective course of treatment for you.

Please bring the completed forms with you during your appointment, along with a copy of your dental insurance card, if applicable.

New Patient Address Form

New Patient Medical History Form

Financial and Appointment Policies

Notice of Privacy Practices

Acknowledgment of Receipt of Notice of Privacy Practices

Authorization for Release of Information

Consent from Patient to Release Dental Records

Schedule an Appointment with Wetherill Family Dentistry...Where You'll Be Treated Like Family!

Contact Us