First Visit Forms

If you are bringing your child to our pediatric dental office for the first time, please complete the new patient forms prior to your first appointment.

Completing these forms and bringing them with you will make your first appointment faster and less troublesome. It also tends to be much easier to complete some of the information, such as current medications, at home where you have this information handy.

Please download and complete the forms below. Those forms that say (Read Only) should NOT be printed and brought to the office. These 2 documents are simply for legal compliance. Only the three documents with asterisks should be printed, completed and brought to the office.

Notice of Privacy Practices (Read Only)

Notice of Privacy Practices Signed Agreement**

Patient Health History Form**

Appointment Policy Agreement**

Please feel free to call us at 513-858-6575 or email us at chewchewjunction@gmail.com!