Shown below are some of the forms used by Dr. Howard. In order to view and print these forms, you’ll need the FREE Adobe Reader program. If you don’t have Adobe Reader, click the icon below and follow the instructions to download it, then install it.

Click the blinking button below to view and print all 6 forms in Adobe Reader.
New Patient form - page 1
New Patient form - page 2

New Patient forms - If you are a new patient who has not previously visited one of our offices, please fill out both pages and bring them with you on your first visit.
Tell Us About Your Smile form
Insurance Q/A
HIPAA form - page 1 HIPAA form - page 2

Tell Us About Your Smile - Tell us what you like and dislike about your smile by answering all the questions, and bring it with you on your next visit to one of our offices.

Dental Insurance - Helpful information regarding your dental insurance and your acceptance of all unpaid balances. Please sign, and return on your next visit.

HIPAA - Privacy Protection and Accountability practices regarding disclosure of your health information. Please feel free to use these pages for your personal reference.

Copyright © Nelson Y. Howard, D.D.S., All Rights Reserved