FORMS

Please download and complete the following forms prior to your visit at our practices in order to expedite your treatment experience.

 
Female white toothy smile

HIPAA SIGNATURE FORM

Dental x-ray
Dental x-ray

PATIENT 

RESPONSIBILITY FORM

Dental Tools in Pocket

FINANCIAL RESPONSIBILITY FORM

Doctor and Patient

MEDICAL HISTORY FORM

Michigan Endodontics

(586)-573-6860

11300 East Thirteen Mile Road

Warren, Michigan 48093

Blue Water Endodontics

(810)-985-7300

Holland Dental Centre

1982 Holland Avenue

Port Huron, Michigan 48060