New Patients - Welcome to Fay Dental Care

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We’d like to get to know you a little better before your first appointment here at Fay Dental Care. We ask that you complete the forms listed below. If you prefer you may also arrive in office 20 mins before your appointment and complete the forms at that time.

What to Expect

Being well-prepared for your appointment will help relieve any unnecessary anxiety you may be feeling. Please take a few minutes to look through our website. There you will find all of the practical information you will need such as a map, directions to our office, practice hours, payment policies and more.  Also take some time to review our staff page and familiarize yourself with the team and our amazing doctors. We look forward seeing you.

 

PLEASE BRING WITH YOU:

  • Your dental & medical insurance cards
  • A complete list of any current medications you are taking
  • Any current x-rays from your previous dentist (Records can be obtained by submitting a formal request to your previous dentist. All records can be sent to Faydental@faydentalcare.com)

  • Patient Information / Adult

  • The following confidential information is important for the dentist to know in planning your dental care. Please answer each question as completely as you can. Thank you.
  • Account Information

  • Person to contact in case of emergency
  • Phone number in case of emergency
  • Health Information - Dental

  • Do any of the following apply to you now or in the past?
  • Health Information - Medical

  • Are you allergic to any of the following.
  • Do any of the following apply to you now or in the past?
  • The above information is correct to the best of my knowledge. I authorize the administration of such medication and performance of such diagnostic and therapeutic procedures as may be necessary for proper dental care.
  • Type full name here.
  • Submission Date: 08/18/2019
  • This field is for validation purposes and should be left unchanged.
  • Patient Information / Child or Teen

  • The following confidential information is important for the dentist to know in planning your dental care. Please answer each question as completely as you can. Thank you.
  • Account Information

  • Health Information - Dental

  • Do any of the following apply to you now or in the past?
  • Health Information - Medical

  • Are you allergic to any of the following.
  • Do any of the following apply to you now or in the past?
  • The above information is correct to the best of my knowledge. I authorize the administration of such medication and performance of such diagnostic and therapeutic procedures as may be necessary for proper dental care.
  • Type full name here.
  • Submission Date: 08/18/2019
  • This field is for validation purposes and should be left unchanged.
New Adult Patient Form
  • Patient Information / Adult

  • The following confidential information is important for the dentist to know in planning your dental care. Please answer each question as completely as you can. Thank you.
  • Account Information

  • Person to contact in case of emergency
  • Phone number in case of emergency
  • Health Information - Dental

  • Do any of the following apply to you now or in the past?
  • Health Information - Medical

  • Are you allergic to any of the following.
  • Do any of the following apply to you now or in the past?
  • The above information is correct to the best of my knowledge. I authorize the administration of such medication and performance of such diagnostic and therapeutic procedures as may be necessary for proper dental care.
  • Type full name here.
  • Submission Date: 08/18/2019
  • This field is for validation purposes and should be left unchanged.
New Child Patient Form
  • Patient Information / Child or Teen

  • The following confidential information is important for the dentist to know in planning your dental care. Please answer each question as completely as you can. Thank you.
  • Account Information

  • Health Information - Dental

  • Do any of the following apply to you now or in the past?
  • Health Information - Medical

  • Are you allergic to any of the following.
  • Do any of the following apply to you now or in the past?
  • The above information is correct to the best of my knowledge. I authorize the administration of such medication and performance of such diagnostic and therapeutic procedures as may be necessary for proper dental care.
  • Type full name here.
  • Submission Date: 08/18/2019
  • This field is for validation purposes and should be left unchanged.