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Patient Form Downloads

These forms require the Free Adobe Acrobat Reader to be installed on your computer.

To speed your service for all appointments in our Overland Park office, Watts Family Dental has provided a few preliminary dental forms on our website. When you visit our office for your appointment, please bring your completed forms with you, and we will see you without delay!

Form List

pdfNotice of Privacy Practices
Our Commitment to your privacy lets you feel secure about your personal and health data. We abide by Federal HIPPA privacy standards.

pdfReceipt of Notice of Privacy Practices
This form tells us that you have recieved and understand our Privacy Practices. Should you have any questions about your rights as a patient and how we handle your private information, please call the office.

pdfWatts Family Dental New Patient Registration – Adult Form
This form is critical in providing treatment to you as well as getting to know you, your family, your insurance and any health issues you have experienced. Please fill out this form as completely as possible.

pdfWatts Family Dental New Patient Registration – Child Form
This form is critical in both providing treatment to your minor/child including the child’s health history, insurance information and proper authorization. Please fill out this form as completely as possible on your child/minor’s behalf.

pdfConsent for Use and Disclosure of Health Information
By signing this form you will consent to our use and disclosure of you protected health information to carry our treatment , payment activities and healthcare operations.

pdfAuthorization to Release Dental Records
This authorization form gives Watt’s Family Dental your permission to obtain dental records, including all current digital images or copies of current x-rays and any other pertinent information that would be necessary for dental care.

pdfALL FORMS: Watts Family Dental Full Form Packet
This is a single download of all forms on this page

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