Patient Forms
Complete your forms before you arrive
Filling these out ahead of your visit saves time in the chair and helps us prepare for your appointment.
Before Your Visit
Patient Screening Form
Health history and screening questions we review before your appointment.
Before Your Visit
Patient Information
Your contact details, insurance and emergency contact information.
Consent
Consent for Porcelain Veneers
Informed consent covering the porcelain veneer procedure and aftercare.
Consent
Informed Consent
General informed consent for treatment at Hollywood Perfect Smile.
Privacy
Protected Health Information (PHI)
Notice of Privacy Practices and how we handle your health information.
Payment
Payment Arrangement Form
Sets out your agreed payment schedule and deposit terms.
Policy
Notice of Non-Show Appointment
Our cancellation and missed-appointment policy.
Questions about any form? Call us at (954) 987-3309 and our team will walk you through it.
