New Patient Forms

Welcome to Redbank Family Dentistry! We are pleased that you have chosen us for your dental needs and we are looking forward to meeting you (and your family). Our mission as your dental family is to provide you with the best dental care available with a gentle and compassionate touch.

Please fill out and bring the following four forms with you to your next scheduled appointment to better expedite your check-in process and minimize your wait time

1. Patient Registration form [Online Form]
2. Medical History form  [Online Form]
3. Financial Authorization and Assignment of Benefits Agreement  [Online Form] 
4. HIPPA Consent form  [Online Form] 
5. Notice of Privacy Practices
6. Appointment Cancellation Policy

To further expedite the process, please have your photo ID and insurance card(s) available at time of check-in. If you have any questions/concerns about your appoinment and/or the following forms provided please call us (843) 797-1161 or email us at [email protected] for us to better assist you.