P: (214) 529-5218 F: (972) 231-9212

Patient Forms

Keeping thorough patient records is an important part of patient care.  We require the following forms to be used in the proper care of surgical patients.  Below you will find generic copies of all patient forms.  You may either download all of the forms by clicking on the top button, or you may download separate, individual forms, as needed.  Your office will receive these forms--customized with your information--in your welcome packet.

Download Patient Registration Forms

Pre-Operative Instructions for Dental Surgery Medical History Update Form Patient Treatment Record

Patient Treatment & Sedation/Anesthesia RecordDisclosure and Consent - Dental and Oral Surgery

Supplemental Disclosure & Consent Form Post-Operative Instructions Following Dental Surgery

Top 10 Do's & Don'ts Acknowledgment of Privacy Policy

Medical Consultation Form
(if required)
 Implant Consent Form
(if required)

Please make several copies of each of these forms, and keep them together in a file for easy accessibility.  I suggest stapling the forms into a packet.  As you refer a patient to me, pull out a stapled packet of forms, tear off the pre-op and medical history forms, and give them to the patient.  Place the remaining forms in the patient chart so they are easy to find on the day of the appointment.

Please be sure to give each patient a written copy of the Pre-Operative Instructions prior to their surgery.  It is a good idea to review the instructions verbally with the patient both at the time of scheduling and again when you make the reminder call for their upcoming appointment.

On the day of surgery, please be sure to place a copy of the remaining forms, along with the treatment estimate, on the outside of the patient chart.  I prefer to review these forms in detail with each patient during their consultation and pre-operative period.


Contact Dr. Moore

(214) 529-5218