3505 Ellicott Mills Drive · Suite B2

Ellicott City, MD 21043

(410) 461-3311

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New Patient Forms

New Patient Forms

When you become a new patient at Ellicott Mills Dental, we will email you a link to fill out your forms securely online.

However, if you prefer, those forms can be downloaded to your computer for review and printed by you at home. 

By filling out these forms prior to your visit, you will save a significant amount of time during your office visit.

Hard copies of these forms are also available to you to fill out at our office.

New Patient Information

General medical history and patient information. This information is useful in making sure you remain safe and properly taken care of during your visit.

HIPAA Privacy Authorization Form

Our office fully complies with HIPAA regulations. This form reviews authorization for use or disclosure of protected health information.

Office Financial Policy

We encourage you to ask questions and to be involved in treatment decisions. This includes understanding your treatment plan as well as our financial policy.

Patient Checking out After their Appointment at Ellicott Mills Dental

If you have any questions about these forms, fill them out the best you can and our friendly office staff will help you fully fill them out when you arrive at our office.

These forms are provided in PDF format. If you do not have Adobe Acrobat Reader, you can download it for free from Adobe’s websites.

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