Patient registration form

A new patient registration form. It collects the patient’s name, date of birth, sex, legal guardian for minors, phone numbers, email, mailing address, employer, and referral source. The insurance section covers the patient’s and spouse’s dental plans, member IDs, and group numbers, followed by a medical health history checklist and a signature line.

Send it before the first visit or hand it out at check-in, then have the front desk enter the information into the practice management system and scan the signed copy. Ask returning patients to review it from time to time so insurance and health history stay current, and keep blank copies at the front desk for walk-ins.