New Patient Forms

NEW PATIENT FORMS
We would like to thank you for giving us an opportunity to serve your dental needs. Please fill out the new patient forms in preparation for your first visit to our office so Dr. Zelina Pickett, DDS can get to know you better.

Click the button to complete the HIPPA FORM.

HIPPA FORM

Click the button to complete the PATIENT REGISTRATION FORM.

PATIENT REGISTRATION FORM

Click the button to complete the MEDICAL HISTORY FORM.

MEDICAL HISTORY FORM

Click the button to complete the DENTAL HISTORY FORM.

DENTAL HISTORY FORM