Patient Forms

If you are a new patient to our office, the attached files contain our patient forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions.

New Patient Forms (Complete All Forms Prior To First Office Visit) 

• Medical History
• Notice of Privacy Act
• Acknowledgement of Receipt of Privacy Act
• Financial Responsibility

Optional Patient Questionnaires

• TMJ Questionnaire
• Sleep Apnea Questionnaire
• TMJ & Sleep Apnea Questionnaire

Referring Doctors

• DOWNLOAD – Dental Imaging Referral Form
• Please send by FAX to 856-428-7644 or EMAIL to cherryhilldentalexcellence@gmail.com with the subject line “Patient Referrals”.
• For more information, please contact us online or call 856-513-2228 .
• ONCE COMPLETED HAVE PATIENT CALL TO SCHEDULE AN APPOINTMENT