Patient Forms

Please download and fill in completely the important information on these forms prior to your child’s first visit with us. You may bring the finished paperwork on the day of your visit, email it to info@wallakids.com, or send to our postal address. We are better able to maximize our time with you and your child if we have your information completed prior to your day.
Thank you!

         New Patient Forms
Patient’s Confidential Information and Medical History
Consent for Dental Care by Non-Parent
Dental Records Release Form
Patient Financial Policy
Consent to use Child’s Photo
Receipt of Privacy Practices
Notice of Privacy Practices

         Infant Frenectomy Forms
Frenectomy Intake Form
Frenectomy Consent
Frenectomy Post Care
Patient Financial Policy
Receipt of Privacy Practices
Notice of Privacy Practices

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