Georgia Dental Medicine

NEW Patient Form Downloads
  • New Patient Medical & Dental History

    Tell us about your past Medical & Dental History

  • New Patient Medical Dental History

    Tell us about your past experiences

  • Authorization to Release Recent X-Rays TO our Office

    This form provides Georgia Dental Medicine℠ permission to request copies of any recent X-rays and medical/dental history from other recent providers. Note that some providers may request you use their own form for this. Here’s what we need at minimum to potentially save you money: All Bite-Wing (one or more teeth) X-rays taken in the last 2 years and Panoramic X-rays taken in the last 5 years

  • Download Bundle - .zip package

    All forms will be downloaded in a ZIP archive file.


READY TO DOWNLOAD?

Click the button below to begin your download. If you have any questions of trouble, please call us directly.

Existing Patient Form Downloads
  • Existing Patient Information

    Existing Patient Information UPDATES; Address, phone, insurance, etc..

  • Existing Patient Medical Dental History

    UPDATE any changes to your medical history

  • Authorization to Release Records FROM our Office

    If you’ve been referred to a specialist please Authorize GDM to Release Recent X-Rays FROM our Office

  • Notice of Privacy Practices

    Each year, current patients must acknowledge receipt of GDM’s Privacy Policy

  • Acknowledgement of Receipt of NPP

    Last one! – Simple acknowledgement form that you understand and have received required HIPPA notfications of privacy from Georgia Dental Medicine

  • Download Bundle - .zip package

    All forms will be downloaded in a ZIP archive file

READY TO DOWNLOAD?

Click the button below to begin your download. If you have any questions of trouble, please call us directly.

Reffered to GDM by another provider?  Please fill out this form prior to your first appointment.  You can bring it with you on your first appointment date.

Have a question, or need some help?