Patient Forms

For your convenience, please click on the buttons below to download our forms, fill them out and bring them with you to your first appointment.

Right-click and Save as/Save link as…To complete the forms, download and save the files to your Desktop. The forms are in PDF format and may be completed with Adobe Acrobat Reader.After you’ve completed and saved the form, you may print them and bring them to our office on your first visit or email them as an attachment to info@blissdentalofdallas.com.

 

New Patient Form » HIPAA Privacy Form » HIPAA Acknowledgement Receipt » Payment Policy »

 

Important Notice

Dr. Sheth and her office are concerned about your personal and medical privacy. If you choose to email your patient forms to our office, you should be aware that while many top-level email systems are password-protected and secure, not all email correspondence is encrypted and your personal information may be visible to third parties (like your internet service provider, employer or another account user.) If you are not sure about the security of your email account, please bring a printed copy of your forms on your first visit. If you choose to email your forms to Dr. Sheth, she and her staff are trained to manage all patient correspondence and medical information according to HIPAA regulations.