Patient Forms
At the dental office of Waseca Dental Care, P.L.L.C., we offer patient forms online so that you can complete them in the convenience of your own home or office. Please submit them after completion. If you would rather print them and fill them out, you can bring the completed forms with you to your appointment or fax them to us beforehand at 507-835-1184.
New Patient Forms
Adult Forms or children 12 and older
- Adult Registration
- Adult Medical History ages 12 and older
- Notice of Privacy Practices
- Consent to Release Health Information For Individual
- Consent to Release Family Health Information For 2 or More Patients
- ARCI
Child Forms for children 11 and younger
- Child Registration
- Child Medical History ages 11 and younger
- Notice of Privacy Practices
- Consent to Release Health Information For Individual
- Consent to Release Family Health Information For 2 or More Patients
If you do not have AdobeReader installed on your computer, Click Here To Download.
Existing Patient Forms: Update your Information
Please take a few moments to update your information prior to your next visit. You can submit the forms after completion. If you have already filled out paperwork at our office and there have been no changes, just update the Adult Medical History or Child Medical History form. If you would rather print them and fill them out, you can bring the completed forms with you to your appointment or fax them to us beforehand at 507-835-1184.
Adult Forms or children 12 and older
- Adult Registration
- Adult Medical History ages 12 and older
- Notice of Privacy Practices
- Consent to send Films for Individual
- Consent to Send Films for Family
- ARCI
Child Forms for children 11 and younger
- Child Registration
- Child Medical History ages 11 and younger
- Notice of Privacy Practices
- Consent to send Films for Individual
- Consent to Send Films for Family
If you do not have AdobeReader installed on your computer, Click Here To Download.
