Patient Forms

At ReGenesis Health Care, we ask each patient to complete the appropriate forms and bring them with you to your next appointment. Please take the time to fill out all the necessary forms and present them upon arrival. Doing so will help us keep all of our appointments on time and will shorten the amount of time it takes for you to receive the care you need. Thank you and we look forward to seeing to you!

Pediatric Registration Packet (2344 KB)

Adult Registration Packet (1999 KB)

Patient Checklist (133 KB)

NO SHOW POLICY (120 KB)

Adult Dental Patient Registration Packet (845 KB)

Dental General Consent To Treat Form (49 KB)

Pediatric and Adult Annual Update Form (433 KB)

Self-Declaration (80 KB)

Pediatric Dental Registration Packet (135 KB)

Sliding Fee (14 KB)

Spanish Forms

Paquete de Registracion de Adultos (515 KB)

Paquete de Registracion de Pediatrico (670 KB)

NO SHOW POLICY - SPANISH (103 KB)

Dental Consent To Treat (34 KB)

Patient Checklist (41 KB)

Pediatric and Adult Annual Update Form (325 KB)

Sliding Fee Spanish (15 KB)

Adult & Pediatric Registration Form Spanish (237 KB)

Self-Declaration Spanish (34 KB)