Forms

For your convenience, please print and complete these forms prior to your first visit.

• Client Information - History Form
• Insurance Information
• Consent for Use and Disclosure of Health Information
• Acknowledgement of Receipt of Notice of Privacy Practices
• Notice of Privacy Practices

These forms are in PDF format, which uses the free Adobe Reader software.

Grand River Dental • 7600 Grand River Avenue #295 • Brighton, Michigan 48114
Tel. 810-225-TEETH (8338) • Fax 810-225-8333 • Privacy Policy

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