Patient Forms

 Thank you for choosing Leipnitz Dental!  As a new patient, please complete the following forms and bring them to your first dental visit or email completed forms to:  [email protected] 

 We look forward to meeting you! 

• New Patient Form (Adult)
• New Patient Form (Child)
• Medical Form
• HIPAA/Financial Form

If you would like us to obtain your dental records/x-rays from a previous dentist, please complete the following form: 

• Release Dental Records to Leipnitz Dental

To read Leipnitz Dental Notice of Privacy Practices, click here .

Note: To download Adobe Acrobat Reader for free,  click here  .