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Patient Forms

Clearsmile provides online forms to make your first visit as smooth as possible.

Because of patient privacy requirements, we cannot accept emailed forms. Please help us protect your privacy by printing the Patient Medical History Form and HIPAA Acknowledegment Form and bringing them with you.

New Patient Medical History
HIPAA Acknowledgement Form

Please read the following form, but you do not need to print it out before your first appointment:

Notice Of Privacy Practices Omnibus Rules

Join the Clearsmile family, and see the difference for yourself.