100 Sparks Valley Road, Suite C, Hunt Valley, MD 21152
Phone: 410-771-8200 | FAX: 410-771-8201


Contact Us page art for Pediatric Dentist Dr. Shari Kohn

PATIENT FORMS

Online Forms

We are now providing our forms for you to fill out prior to your visit! Thank you for taking the time to do this at least 1 business day before your child’s appointment.

Note: Due to the COVID-19 Pandemic, the COVID-19 screening forms must be filled out in advance of your appointment. This ensures the health and safety of our patients, staff and community. If you are unable to do so, we may need to cancel your appointment. As always, should you have trouble, please call the office.

New Patient Forms Routine Dental Check Up Restorative Appointment

Having trouble filling out forms for multiple children? Open the form you need filled out again, (even though the box is checked green) and change the name at the top to reflect the appropriate child. As long as you push “submit” after you complete, we will receive the updated forms under each child separately! Feel free to call us if you have any trouble!

COMING SOON: New Patient Forms available ONLINE! Thanks for your patience as we prepare these forms for you!

Downloadable Forms

For your convenience prior to visiting our office, please click on the links below to view and print the necessary forms and policies, complete the information and bring them with you to your first visit.

Please bring completed forms with you to the office signed by the child's legal guardian.

For the first visit the following forms are needed.

New Patient Health History Form Financial Policies Notice of Privacy Practices Acknowledgement of Receipt of Notice of Privacy Policies Email and Text Authorization Form

If other appointments are needed these forms may be necessary prior to a second appointment.

Nitrous Oxide Consent Sedation Instructions Sedation Consent Immolibilization Consent O.R. Consent Form Insurance

These are our Office Policies for Patient Treatment

Treatment of Minors Policy for Patients 18 years of age and older

Existing Patients ONLY- if you have not been in to the office since Jan 2018, we are updating our records. Please fill out the form attached to Update your child's Medical History. Thank you!

2018 Health History Update