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For your convenience, we have supplied a printable version of
our Patient Health History Form. Please complete and return it to us during your next office visit.
Feel free to call us if you have any questions, and we
will assist you.
Health History Form
The Health Insurance Privacy and Portability Act (HIPAA)
is a federal law designed to protect your personal health information. Willits
& Woltkamp Family and Cosmetic Dentistry is HIPAA compliant. For your
convenience, we have provided a printable version of our HIPAA Notice of Privacy
Practices and Acknowledgement forms. For new patients, please print, sign and
bring the Acknowledgement form to your first visit.
Notice of Privacy
HIPAA Acknowledgement Form
Free Adobe Acrobat
Reader
(necessary for viewing and printing these forms)
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