As you may know, several medical and dental conditions are inter-related. Therefore, a thorough and accurate Health History is important to ensure that you receive the highest quality dental care in the safest manner possible.

Please click on the link below to view and print our two-page “New Patient Application: Health & Dental History Form.”

If you are interested in our Privacy Policy, you can view it by clicking on the appropriate link. You do NOT have to print this form or bring it with you to your first visit if you do not want to. If you prefer, you can sign this document when you arrive at our practice.

Due to HIPAA privacy regulations and privacy concerns, these forms may not be completed on-line.

Instead, please print the appropriate form(s) on regular paper, fill it/them out, and bring it/them with you to your first visit with us.

Having your paperwork completed ahead of time will save you time when you arrive, and also give you a chance to consider your answers carefully, so that they are as complete and accurate as possible.

New Patient Application: Health & Dental History Form

Privacy Policy / HIPAA

Please click on the links above to download and print your New Patient Form.

You may also print our Privacy Policy and bring a signed copy with you to your first visit. Or, you can sign this form when you arrive.

If there are questions which you do not understand, are unsure about, or wish not to answer, please discuss these with Dr. Wolter during your upcoming visit.

If you have any questions, or need any other assistance, in advance (before your first visit), please call us and we’ll help you any way we can.

All personal medical information will be kept confidential, as prescribed by applicable federal and local laws, as well as the Code of Ethics of the American Dental Association.