Patient Forms

Before your visit with our dentist, remember to fill out our patient forms. This will allow Dr. Haley Miller to ensure you are receiving the right dental care according to your oral medical history and previous treatments. Call us at 985-845-3120 today for any questions about our forms or to schedule your visit at our dental practice in Madisonville, Louisiana.

HIPAA Form
Medical History Form
Patient Information Form
Neurotoxin Consent Form
Filling Consent Form
Crown Bridge Consent Form
Clear Aligner Consent Form
Annual Update Form
Financial Agreement Form
Denture Consent Form
Extractions Consent Form
Botox Instructions