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New Patient Forms

If you're a new client, please complete the following form and bring it to your first visit to our dentist office.

New Patient Form
Agreement to Pay for Treatment Form
Dental History Form
Medical History Form


If you would like us to coordinate with another dental clinic to request x-rays, please complete this form:

X-Ray Release Form
HIPAA Authorization Form


Our Location

30 East 9th Street, Suite 1A | New York, NY 10003

Office Hours

By Appointment Only

Monday:

9:00 am-6:00 pm

Tuesday:

9:00 am-6:00 pm

Wednesday:

9:00 am-6:00 pm

Thursday:

9:00 am-6:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

Contact Us Today!

We look forward to hearing from you.