Patient Forms

Outstanding dental health for a lifetime, or finally having the beautiful smile of your dreams — whatever your goals, our suggestions for your care are based upon sound principles and the highest standards of care that insure you the best long-term results.


Your initial appointment enables us to review your medical and dental history, discuss your treatment goals and conduct a comprehensive dental examination. Once we gather all essential information, we will share our findings and provide you with information and options to achieve your goals. After this visit, our front desk staff will assist you in getting scheduled back for the appropriate amount of time for your first cleaning here.


Please provide the following at the time of your initial consultation:

IMPORTANT: Patients under 18 must be accompanied by a parent or guardian. Please alert the office if you have a medical condition that may be of concern, such as a heart murmur, diabetes, high blood pressure, artificial heart valves or joints, rheumatic fever, etc.; or if you are on heart medications, aspirin therapy, anticoagulant therapy, etc.

Save time by completing necessary forms before your appointment. The forms below require Adobe Acrobat Reader (click for free download).

New Patient Paperwork


Request Dental Records from your Previous Dentist

Request Dental Records from Highpoint Dental Medicine * Please complete as required, print, review, sign and bring to your office visit.

X-Rays If your doctor has taken x-rays, you may request that they forward them to our office or we will call and request them for you. If there is not enough time, please pick them up and bring them to our office. If any additional x-rays are necessary, they can be taken at our office.

Insurance - click here for information.

Please contact us at 215-822-1866 or by e-mail at info@highpointdental.com if you have any questions or to schedule an appointment.   

We're looking forward to giving you the quality smile you deserve!


Call Us Today!
(215) 822-1866