New Patient Forms - Kidz-R-Kool Pediatric Dentistry, Peoria, AZ
To save time at your child’s first visit, download and complete our patient forms ahead of time and bring them with you. Kidz-R-Kool Pediatric Dentistry provides a new-patient form, registration and medical history, insurance information, and consent forms.
Getting ready for your child’s first visit is simple. Completing your forms in advance means less time in the waiting room and more time for the fun stuff. Please fill out the forms below and bring them with you (or complete the online new-patient form), along with your insurance card and any relevant medical history.
Download Your Forms
- New Patient Form - complete online to get your child registered before you arrive.
- Patient Registration & Medical History Form - your child’s basic information and health history.
- Dental Insurance Information Form - so we can verify your benefits and file claims for you.
- Legal Consent to Make Decisions Form - required if someone other than a parent will bring your child in.
- Consent Statements Form - our standard treatment and office consents.
Questions? We’re Here to Help.
If you have any trouble with the forms, just call (623) 572-5777 - we’re glad to help. New to the practice? See what to expect at your child’s first visit. Kidz-R-Kool Pediatric Dentistry is at 7505 W Deer Valley Rd, Suite 110, Peoria, AZ 85382.
