Kenneth M. Dixey, D.D.S.

Documents

These forms are all necessary for new patients. For your convenience, you can fill them out before–hand, and bring them with you to your first appointment.

Secure Online Forms

Want to fill out the forms online? Use the Secure Online Forms, here's how it works:

Fill out all of the necessary information in the order you please, the checklist will keep track of the information you have provided.
Once you have completed all necessary information, print the forms out. You can now sign them and bring them to your first visit.
After printing, click the clear your information button.

Use Secure Forms Start using Secure Online Forms.

Ready–to–Print Documents

The following documents are ready to print. After printing them, you can fill them out by hand. PDF is a standard file format; you may need a viewer such as the Adobe Reader in order to view PDF files.

Privacy Policy "privacy_policy.pdf" (84 KB)
Consent for Use and Disclosure of Health Information "consent.pdf" (92 KB)
Patient Information "patient_information.pdf" (60 KB)
Patient Health History patient_health_history.pdf (63 KB)