Patient Forms

New patient? Please download and fill out the following forms when you come in for your first appointment.

Patient Medical History Form/Privacy Notice

These forms are mandatory for all new patients. To expedite your visit, print these forms and fill them out at home.  Please bring all four (4) them with you to your first visit..

Medical History Forms (3)

Patient Health History.pdf
Adobe Acrobat document [118.4 KB]
Patient Info.pdf
Adobe Acrobat document [111.0 KB]
Child Info.pdf
Adobe Acrobat document [106.7 KB]

 

 

Privacy Notice (HIPPA)

Please read over and sign our Notice of Privacy Practices, acknowledging our privacy policy. This form should also be brought to your first appointment.

Privacy Notice
HIPAA Consent.pdf
Adobe Acrobat document [113.6 KB]
Privacy Notice
Office Policy.pdf
Adobe Acrobat document [162.4 KB]

Make an Appointment Today!

24 hour emergencey contact info is as follows: 

James J. Fehrman, D.D.S.   810. 577. 9673

James H. Ford, D.M.D.      810. 931. 5973

24 hour Emergency Contact 

Keep Your Teeth Healthy!

Preventive care is the best way to keep your teeth healthy.  Brushing for two minutes twice a day and flossing will make your next dental visit easier and more pleasant.  

Get Social With Us

Print Print | Sitemap
Hilltop Dentists, P.C.

Call

E-mail