Timothy H. Kindt, DDS
Cosmetic and Family Dentistry
1244 N Greenfield Road, Suite 105, Mesa, AZ 85205
Phone: 480-981-0094 • Fax: 480-396-6271
(480) 981-0094
Ignoring mouth pain or postponing dental care can adversely affect your general health and your budget.
Download these forms and fill them out before you come in to the office to save time.
FIRST VISIT FORMS
Ensure that you don’t have to wait any longer than necessary by filling out these forms before your first visit. If you do not understand some questions, we can answer them when you come in. Please see Scheduling Your First Visit for other appointment questions, or feel free to call us at 480-981-0094.
- Medical History Form, Including medication and supplement listings
- Patient Consent for Release of Medical Information
- Notice of Privacy Practices (HIPPA Form)
- Financial Responsibility Form
TREATMENT CONSENT FORMS
If you are scheduled for a tooth extraction/removal or a root canal, please download and fill out the appropriate form prior to your visit:
- Informed Consent for Root Canal Therapy
- Informed Consent for Oral Surgery (tooth extraction/removal)
Please see After Treatment Home Care for post-operative instructions.
