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Printing our Documents

To print our patient forms you must have Adobe Acrobat Reader installed on your comnputer. If you do not have Adobe Acrobat Reader, you may download it here for free.

Patient Forms Library At Rocklin Dentist

This is our patient forms library. You can always complete these forms when you arrive at our office, but we also provide them here so that you can print them out, complete them and have them ready when you arrive for your first visit.

HIPPA - Patient Consent Form

Our Rocklin dentist office abides by Federal law which requires that medical information collected on patients only be disclosed to insurance companies and other health care organizations after written permission to do so has been obtained. We provide this form to you when you visit our Rocklin office for the first time. Print the Patient Consent Form to fill out before arriving at our office to save some time..

New Patient Form

As a new patient of Dr Smurthwaite, it is important that we get a clear picture of your past and present health status. This new patient form helps us to gather all the initial information we need to provide you with the best care possible. Our Rocklin dental team will review your information and make sure that all your dental needs are met in a safe and thorough manner. Print the New Patient information form to fill out before arriving at our office to save some time.

Cancellation Policy Acknowledgement

Out of respect for other clients and the time of Dr Smurthwaite and his staff, we have provded this cancellation policy acknowledgement for you to download, read, sign, and submit with your patient forms. Our goal is to provide the best service to each of our patients. Our cancellation policy and assoicated fees help us mitigate the costs assoicated with missed appointments.