Office Forms

These forms are available to download, view and complete before you come to our office for your initial visit.
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Welcome to our Practice This form requests your personal information, dental and medical history. Please print this form and bring it with you to your first office visit. This will save time at the office.
Notice of Privacy Practices This informs you of your privacy rights according to the Health Insurance Portability & Accountability Act of 1996 ("HIPAA").
Notice of Privacy Practices Acknowledgement This form acknowledges that you have read and agree to your privacy rights according to the Health Insurance Portability & Accountability Act of 1996 ("HIPAA"). Please print this form, sign and date it, and bring it with you to your first office visit.

Dolberg Dentistry ©2009
4390 N. Miller Road, Suite 106 | Scottsdale, AZ 85251
(480) 949-5858 | dolbergbrian@gmail.com