Welcome,
Within this section, you will find our office forms. New patients or patients not seen within 5 years, please, complete all forms within the “new patient” tab; this will include the patient information with medical history, HIPAA, Financial/Assignment of Benefits, and a verbally records release. You may also find the form descriptions below.
Once completed you may return paperwork by fax, email or upon check-in of your appointment. Please email paperwork or records to our front desk at frontdesk@favourdental.org
New patients, our team kindly ask to please arrive 10 minutes prior to your appointment time if your paperwork is completed. If you are unable to complete the paperwork prior; our team will kindly provide the forms upon check-in however we ask to arrive 20 minutes prior to your appointment time. This helps our team still on time for all appointments and provide all appointment services within your scheduled time.
Patient Information is per patient however the HIPAA and Assignment of Benefits & Financial Agreement may be for a household, all dependents may be listed within the form.
If you have any questions please do not hesitate to contact the office.
Forms: Patient Information - this form is patient information including name, numbers, and medical history. This form will need to be update once a year.
HIPAA - standard HIPAA rules and regulations
Assignment of Benefits and Financial - allows our practice to bill directly to your insurance. Reviews the office’s policy along with our missed appointment guidelines.
Records Release - provided so a patient may be able to request certain information by a call and only to your listed email on file, if the form is on file and dated within a year; you may call our staff without having to send a release every time. Records may not be sent to patient or referral without a records release on file.
Thank you!
Phone: 281-259-6717 | Fax: 1-888-799-3076
frontdesk@favourdental.org | info@favourdental.org
Business Hours : Monday - Thursday | 8:30am - 2:30pm