Patient Forms
At Quincy Center for Endodontics, our patient forms are a vital part of delivering efficient, personalized care. These documents provide us with essential medical history, insurance information, and treatment consent—ensuring we can tailor each visit to meet the unique needs of every patient. Completing the forms in advance helps streamline the check-in process and allows our team to focus on what matters most: your comfort, safety, and exceptional care.
Patient Forms
Patient Registration
The patient registration form collects essential personal, medical, and dental information to help our team provide safe, effective, and personalized care. Completing this form prior to your visit ensures a smoother check-in process and allows us to better understand your treatment needs.
Medical History
The medical history form for Quincy Center for Endodontics provides our team with important information about your overall health, medications, and past medical conditions. This helps us ensure your safety and tailor your endodontic treatment to your specific health needs.
Notice of Privacy
The Notice of Privacy Practices form explains how your health information may be used and shared, in compliance with HIPAA regulations. It also outlines your rights regarding your personal health information and how you can access or request changes to your records.
Financial Policy
The financial policy form outlines our payment expectations, accepted insurance plans, and billing procedures. It ensures transparency and helps patients understand their financial responsibilities before receiving treatment.
Consent to Contact
The consent to contact form authorizes our team to reach you via phone, text, or email regarding appointments, treatment updates, and billing matters. This ensures timely communication and helps us provide efficient, coordinated care.
Post-Op Instructions
Post-operative instructions provide guidelines to help you care for the treated area and promote proper healing after your procedure. Following these instructions carefully can reduce discomfort, prevent complications, and ensure the best possible recovery.
Patient Comfort is Our Mission
Same Day Appointments are Available.