New Patient Paperwork
We are delighted to welcome you and your family to Michael J. Leach D.D.S. Pediatric Dentistry. Below you will find links to our New Patient Paperwork and our Additional Sibling Form.
Gone are the days where you spend what feels like the majority of your time filling out the mountain of paperwork upon arrival to your child’s appointment. Your time is valuable, so we have streamlined the paperwork process for you. We now offer one secure online form that comes directly to our team. All information that is submitted via the online form remains confidential and is only accessible by select members of our team. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
Once you click the appropriate link below (New Patient Paperwork or Additional Sibling Form), you will be redirected to a secure online portal. From there, you can fill out the required fields online and have it electronically sent to the Michael J. Leach D.D.S. Pediatric Dentistry team or you can download the form and manually fill in the fields. After you have completed the form online, please make sure to press the Complete and Send button at the bottom to automatically send us your information.
If you have more than one child visiting our practice, please also fill out the additional sibling form. All forms must be completed prior to your child’s appointment. Click the links below to access the appropriate paperwork; if you have any questions or concerns give us a call at 770-521-8855.
Online New Patient Forms Online Additional Sibling Forms
If you prefer to print out our patient forms and bring them in, please find the PDF version of our forms below:
- New Patient Form
- Additional Sibling Form
- HIPPA Policy
- Broken Appointment Policy
- Payment Policy
- Photo Release Form
- Privacy Policy
- “Get To Know You – ages 5 and under”
- “Get To Know You – ages 6 – 13”