Patient Forms

Ann Arbor Michigan Dentist New Patients and Forms
For Your First Visit

We are honored to be your dental provider! We realize filling out paperwork is time-consuming; therefore, we have made every effort to minimize the paperwork required for our patients, while still obtaining the information we need to provide you with the highest quality service possible.

 

In order to make better use of your time at our office, we have provided you with the below registration forms. The forms included in this registration packet enable us to learn about your dental history and how it affects your overall health, track the effectiveness of any treatments you may receive, and accurately bill your insurance.  

 

**IMPORTANT** 
The first three forms must *FIRST* be downloaded and saved to your computer before editing electronically.  This is done by "mousing over" the right bottom corner of the page and clicking on the disk icon.  Once saved, forms can be filled in on your computer but must be re-saved with updates before attaching and emailing to us at accounting@kotredental.com.  The forms may also be printed at home and brought into the office at your next appointment. 

 

 

 *View HIPAA Omnibus Notice of Privacy Practices

**Please note that Google Chrome or Internet Explorer are required in order to fill out the forms online.

Ann Arbor Dentist, Dentist in Ann Arbor Michigan, Emergency Dentistry, Pediatric Dentistry