Forms

We want your visit to be smooth and pleasant, so we took our most common forms that patients like you have filled out, and gathered them here. If you fill out the forms on this page and bring them to your appointment, we'll be that much closer to having you on your way with a great smile!

Please click the form name(s) below to download and prefill the forms.

A patient fills out a form ahead of time

Patient Registration

Patient Acknowledgement of Receipt of Notice of Privacy Practices

Health History

Medical Update

Treatment Authorization for Minors

HIPAA Notice of Privacy Practices

Your neighbor says

I never looked forward to seeing a dentist until Dr. Truitt. He truly is the very best of Polk County. He has the most friendly staff you could ever encounter. I really enjoy my visits! It is always pain-free. Thank you for caring and making my visits such enjoyable experiences. You always go the extra mile!

Candi, from Winter Haven