Practice Name

Specialty

City, State

Phone

Online Forms

517 E. Lancaster Ave.
Shillington, PA 19607

610.777.7646

 

426 West Main Street
Kutztown, PA 19530

610.683.6000

Patient Oral Surgery Consent Forms

Please download and fill-out our Patient Consent Form, to authorize oral surgery, and use of any neccessary anesthesia and medications. After you have completed the form, please make sure to bring it on your first visit to our office. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Technical Note:

Mac Users: You must open and submit the form in a Safari Browser and also have the latest Mac Operating System. It is important you also have the latest version of Adobe Acrobat Reader on your computer in order to submit your form to our office correctly. Please download the free plugin from Adobe's web site.

PC Users: Our online registration forms use the Adobe Acrobat Reader 5 or greater plugin to conveniently submit your health history and registration information from home or work. Please download the free plugin from Adobe's web site if it is not already installed on your system. It is important that you have at least version 5 of the plug-in to successfully use our online registration forms.