Patient Forms

Hello!

If you are considering the White Street Smiles dental team for the first time, visit our New Patients page for an in-depth look at what to expect before and during your first dental visit.

Current patients of record can update personal or medical information, for yourself or a minor, using our downloadable dental forms below. Once complete your dental forms, you may:

  1. Bring them to your appointment
  2. Drop them off anytime before your appointment
  3. Mail/courier them – anticipating the lead time needed for us to receive them

For your protection, Do Not email dental forms to White Street Smiles.

Thank you.

Sincerely,

Dr Joann Paiva-Borduas DDS
White Street Smiles

P.S. We’re here to answer your questions. Just call 203-743-4670 or visit our office at 289 White Street Danbury CT 06810.

HIPPA compliance

Need a refresher? We recommend taking time to review the data privacy and security provisions under the Health Insurance Portability and Accountability Act (HIPPA).

Go ahead. Visit the HHS.gov website right now, and we’ll hold your spot!

Appointments

Do you need to schedule/reschedule an appointment? Call 203-743-4670.

Forms

Up-to-date information is integral to the ongoing service and treatment path we provide. Your dentist prefers taking care of you, not your paperwork and patients tell us that updating their forms early, saved them time at the office.

If you have difficulty accessing or understanding any form, call our Danbury, CT office team – 203-743-4670.

Select either Adult or Minor patient type, download, and done!

  1. Click WSS Adult Dental Patient Forms below to open a new window with the forms in PDF view
  2. Click the Printer icon (select grayscale or black/white color, and single sided paper options if asked) to print the entire forms package
  3. Read each form and Complete all the required fields
  4. Print Your Name, Sign, and Date the forms to acknowledge your receipt, and understanding of their content

NOTE: If you wish to clarify a question/answer, please arrive 15 minutes prior to your scheduled appointment, or stop in during office hours.

If you’d like the forms package(s) to reside on your computer, just click Save while the PDF viewer window is open. You will need a PDF file reader to view them later – download Adobe Acrobat Reader® free.

WSS Adult Dental Patient Forms

  1. Click WSS Minor Dental Patient Forms below to open a new window with the forms in PDF view
  2. Click the Printer icon (select grayscale or black/white color, and single sided paper options if asked) to print the entire forms package
  3. Read each form and Complete all the required fields
  4. Print (Parent/Guardian) Name, Sign and Date forms to acknowledge your receipt, and understanding of their content

NOTE: If you wish to clarify a question/answer, please arrive 15 minutes prior to your scheduled appointment, or stop in during office hours.

If you’d like the forms package(s) to reside on your computer, just click Save while the PDF viewer window is open. You will need a PDF file reader to view them later – download Adobe Acrobat Reader® free.

WSS Minor Dental Patient Forms

White Street Smiles Danbury CT Dentist

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