Forms
Please download the PDF to fill out your form or click the link below to access the online forms for your convenience.
Prosthodontic
Referal Form
Medical Clearance Form
Release of Records
Dental History
Please complete the dental health history form. The information you provide informs Dr. Najafi and Dr. Jayne to properly approach your dental care.
Medical History
Please complete the medical health history form. The information you provide informs Dr. Najafi and Dr. Jayne to properly approach your dental care.
Patient Registration
We honor your right to privacy. This form explains how we handle HIPAA and Protected Health Information records in our dental practice.
Financial Policy
HIPAA Acknowledgement
Use the buttons below to download the forms. the forms below are for Acknowledgement of Privacy Practices and Notice of Privacy Practices.