Patient Forms

Thank you for entrusting Growing Smiles Pediatric Dentistry with your child’s smile.

To expedite your experience when you arrive, we prepared the following electronic forms to fill out and submit online.

Online Patient Forms

COVID-19 Patient Disclosure
New Patient Registration Forms + HIPAA
Non-parent Consent
Medical History Update
Multiple Children Medical History Update
Authorization to Release Dental Records
Notice of Privacy Practices

**Note that these forms are intended to be submitted online ONLY. If you prefer to fill out and print your forms, please click here.

Growing Smiles Pediatric Dentistry Valparaiso