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Family and Cosmetic Dentist Allen TX
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Clearstone Dental
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New Patient Forms

By James Vu
On August 20, 2015

We are glad you have decided to come to our office and thank you for the opportunity to address your oral health concerns.  Please print and fill out these forms and bring to your appointment to expedite the check-in process:

Clearstone Dental Notice of Privacy Practices (Read but do not have to bring to appointment)

Acknowledgement of Receipt of Hipaa Notice of Privacy Practices

Authorization for the Release of Protected Health Information

Medical History

2015-08-20

About Clearstone Dental

Family & Cosmetic Dentistry serving the Allen, Fairview, Lucas and surrounding communities.

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1228 East Exchange Parkway
Suite 120
Allen, TX 75002
Phone/Fax: (214) 377-0712
clearstonedental@gmail.com

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