New Patient Forms
Complete your forms before your visit to make check-in faster and ensure we're fully prepared for your appointment.
First Visit? To help make your first appointment as smooth as possible, please complete these forms in advance. You can download, print, and bring them in — or arrive 15 minutes early to complete them at our office. All information is kept strictly confidential in accordance with HIPAA regulations.
Patient Forms
Click any form below to download. Adobe Reader is required to view PDF files.
New Patient Registration Form
Complete this form with your personal and demographic information. Required for all new patients on their first visit.
Download PDFMedical History Form
A comprehensive health questionnaire covering current medications, allergies, medical conditions, and previous dental history. Essential for safe treatment planning.
Download PDFHIPAA Privacy Notice & Acknowledgment
Our Privacy Notice explains how we protect and use your personal health information. Please review and sign prior to your first visit.
Download PDFDental Insurance Information Form
Provide your insurance carrier, policy number, and subscriber information so we can verify your benefits before your appointment.
Download PDFFinancial Policy Agreement
Our financial policy outlines payment expectations, insurance coordination, and available payment options. Please review before your visit.
Download PDFWe Work With Most Insurance Plans
Houston Medical Center Dental accepts most major dental insurance plans. Contact us before your appointment to verify coverage and confirm your benefits. We'll help maximize your insurance and minimize out-of-pocket costs.
* Don't see your insurance? Contact us — we may still be able to help. We also offer flexible payment options.
Payment Options
We accept all major credit and debit cards, personal checks, and offer online payment for your convenience.
Make a Payment OnlineReady for Your First Visit?
Our friendly team is ready to welcome you. We'll make your first appointment easy and comfortable from start to finish.