Endodontic, Periodontic and Orthodontic Specialists

700 E. Campbell Rd. | Richardson, TX 75081

Call us directly: (972) 479- 1200

Patient Registration

Please download and print out all the forms underlined below, complete them, and bring all of them with you to your appointment.The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it. Thanks.

Endodontic History Form

Patient Privacy Policy

This form, Notice of Privacy Practices, presents the information that federal law requires us to give our patients regarding our privacy practices.

Financial Responsibility Form

Technical Note:

You need Adobe Acrobat Reader to view our forms, which are pdf documents. Please download the free Acrobat Reader from Adobe’s web site if it is not already installed on your system or if you experience difficulty reading or accessing any of the links above.