Patient Forms

Complete your paperwork online — before you even walk through our door. All forms are submitted securely and go directly to our team.

New Patients

New Patient Welcome Packet

First time visiting us? Download and complete your new patient paperwork before your appointment to save time at the office.

Approx. 10–15 min Download PDF

HIPAA Required

Records Release Consent Form

Authorize your previous dental provider to transfer your records to Merchant's Walk Dental. HIPAA-compliant digital signature included.

Approx. 3–5 minOpen Form

Direct to Patient

Request Your X-Rays

Need a copy of your dental x-rays? Submit a request and we'll send them directly to you by email or mail within 1–2 business days.

Approx. 2–3 minOpen Form

Insurance

Insurance Information Update

New insurance? Changed plans? Submit your updated member ID, group number, and a photo of your insurance card so we have everything on file.

Approx. 2–3 minOpen Form

Annual Update

Annual Contact & Address Update

Moved recently or changed your phone number? Keep your contact information current so we can always reach you.

Approx. 1–2 minOpen Form

Your information is secure

All forms are submitted directly and securely to our office. Your personal and health information is handled in accordance with HIPAA privacy regulations and will never be shared with third parties.

Need help with a form or have a question? Contact us or call (770) 691-5051.