Patient Forms
Save time at your appointment by completing your paperwork before you arrive. Fill out forms online or download them to print and bring with you.
Complete Online
Fill out forms on any device. Your information is securely saved for your visit.
Print & Bring
Download PDF forms, complete at home, and bring them to your appointment.
Complete at Office
Prefer to fill out forms in person? Arrive 15 minutes early and we'll help you.
Required Forms
These forms must be completed before your first appointment.
New Patient Form
RequiredContact details, medical and dental history, insurance, and consent. Complete this before your first visit.
Additional Forms
These forms may be required depending on your situation.
After You Complete Your Forms
Schedule Your Visit
Find a location near you and book your first appointment online or by phone.
Arrive on Time
Bring your completed forms (if printed), ID, and insurance card to your appointment.
Enjoy Your Visit
With paperwork done, you can relax and focus on your dental health!
Information We'll Ask For
Personal Information
- Full legal name and date of birth
- Current address and phone number
- Email address for appointment reminders
- Emergency contact information
- Preferred language
Medical History
- Current medications and dosages
- Known allergies (especially to medications)
- Previous surgeries and hospitalizations
- Chronic conditions (diabetes, heart disease, etc.)
- Current physician contact information
Dental History
- Previous dental office information
- Date of last dental visit
- Current dental concerns or pain
- History of dental procedures
- Dental anxiety or phobias
Insurance Information
- Insurance provider and plan name
- Policy holder information
- Group and member ID numbers
- Secondary insurance (if applicable)
- Employer information
Your Privacy is Protected
All information you provide is protected under HIPAA (Health Insurance Portability and Accountability Act). We use industry-standard encryption and security measures to keep your data safe.
Ready to Schedule Your Visit?
Now that your paperwork is ready, find a Rodeo Dental location near you and book your appointment.
Give Your Family
The Care They Deserve.
Join 500,000+ families who trust Rodeo Dental for preventive services