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Patient Forms

The following forms are for new patients to complete prior to their first visit. Please bring the completed form with you to your first appointment and present them to reception. We look forward to meeting you!

Patient Registration/Medical History Form
HIPAA Notice of Privacy Practices
HIPAA Consent Form

Our Location

Dushore Dental Services
232 South German Street
Dushore, PA 18614
(570) 928-8618
Hours:
  • Mon, Tues & Thurs
    8:30am – 4:30pm
  • Wed By Appointment
  • Closed Fri – Sun

Patient Education

Patient education library includes information on various topics ranging from dental care to oral health problems.

Access Patient Library ยป

Dental Health Partnership

A Dental Insurance Alternative

  • Facts
  • Fees
  • Forms
  • Home
  • About Us
  • Patient Education
  • Appointment Requests
  • Contact Us
  • Services
  • Galleries
  • Dental Videos
  • Patient Forms
  • DHP

© 2019 Dushore Dental Services.