Patient Forms

On your first visit to our office, we will need a completed patient registration form. To expedite your initial appointment, please complete this form (along with a list of all medications you are currently taking) and email or bring it to our office. It is critical that this form be completed accurately to ensure that Dr. Noohi and dental team are aware of all medical conditions prior to treatment. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.  Other consent forms are provided and should be completed as directed by Dr. Noohi.

Patient Registration: This form includes your contact information, health information, dental history, emergency contact information, insurance information as well as our office policies.

Request for Dental Records: Patients can download this form to authorize the transfer of records/x-rays to Dr. Noohi’s office.

HIPAA Privacy Policy: This form describes our practices regarding the handling of your personal health information in compliance with federal law.

Dr. Referral Slip: Referring Doctors can download our referral slip to provide us with information about the patient and his or her dental condition.

Permission to Use Full Face Images: Dr. Noohi is involved in providing continuing education to other dentists. He may request that you provide permission to show your face in pictures presented in clinical presentations. You are not obligated to provide this permission.

Consent for Biopsy with Local Anesthesia

Consent for Crown Lengthening

Consent for Soft Tissue Augmentation and Root Coverage Surgery

Consent for the Surgical Placement of Dental Implants

Consent for the Use of Bone Regenerative Procedures

Consent-for-Consent for Tooth Extraction and GBR

Financial Policy

Implant Referral

Pre-Surgical Instructions

Post-Surgical Instructions