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817-735-4700

Patient Forms

New Patient Forms

Please ensure that you fill out all applicable forms prior to your visit

(* indicates required for ALL new patients)

New Patient Information*
Medical and Dental History*
Lamberg Questionnaire*
Epworth Questionnaire*
Photo Release*
Notice of Privacy*
Consent and HIPAA*
Financial Policy*
Payment Options*
Records Transfer Request*
Breast Feeding Questionnaire
Pediatric Sleep Questionnaire

Post Dental Treatment Instructions

Debridement Instructions
Scaling & Root Planing Instructions
Temporary Crown Instructions
Post-Op Instructions Gingival Graft

Post Frenectomy Instructions

Baby Post-Op Instructions
Adult Post-Op Instructions

Miscellaneous

Xylitol Information
Insurance ADA form
Headache Log
Blood Pressure Log
What is Myofunctional Therapy
Sleep Hygiene Fundamentals

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Hours of Operation

Our Regular Schedule

Monday:

9:00 am-5:00 pm

Tuesday:

9:00 am-5:00 pm

Wednesday:

9:00 am-5:00 pm

Thursday:

9:00 am-2:00 pm

Friday:

9:00 am-2:00 pm

Saturday:

Closed

Sunday:

Closed

Whitening, TMJ, TMD, Migraine Headache, AGGA Biobloc Alf DNA TAP Appliance, Orthotropics, Epigenetic Orthodontics, Cosmetic Laser Dentistry, Implants Crown, All on Four, Invisalign, Postural Restoration Institute, Craniofacial Dystrophy, Airway Centric Dentist, Breathing, Lip Buccal Tongue Tie, Breastfeeding, Nursing, Fillings, Myofunctional Craniosacral Speech Physical Therapy, Myofascial Massage, Veneers, Bridge, Partial Implant Overdenture Denture, Mewing, Tonsil, Adenoid, Deviated Septum, Turbinate Reduction, Neck Back Hip Pain, Scoliosis, Braces, Cranial Strain, Craniomandibular Orthopedics, Abscess, Deep Front Line, Cranial Nerve Function, Infant Frenectomy Stretches, Nasal Sinus Surgery, Root Canal, Mandibular Advancement Appliance, MAA, MMA Surgery, UPPP, NightLase, OroLase, BabyLase, LipLase, Snoring, Obstructive Central Sleep Apnea, Enuresis, Nocturia, ADHD, ODD, MTHFR C677T A1298C Factor V Homozygous Heterozygous Gene Mutation, ADD, Brain Health, Functional Anterior Galella Growth Appliance, Tooth Decay, Cavity, Riva Star Silver Diamine Fluoride, Fort Worth Benbrook Tarrant County Family General Physiologic Pediatric Childrens Holistic Sleep Dentist, Flossing, Brushing, Dental Medical Insurance, Nierman, OralDNA, Digital, Prosomnus, Snore, CPAP, Birth, Midwife, Doula, Bebe Myomunchee, Ankyloglossia, Anxiety, Autism Spectrum Disorder, ASD, Special Needs, Vaccine Injury, Buteyko, OMT, Down Syndrome, Ehlers Danlos, TRS, Arnica, Rescue Remedy, Folate Folic Acid, Homocysteine, Oral Surgery, Endodontics, Periodontal Gum Disease, Periodontics, Prophylaxis, Extraction, Toothache, Chiropractor, EyeLase, TightLase, Facelift, Botox, Stroke, High Blood Pressure, Diabetes, Gluten, Autoimmune, Rheumatoid Arthritis, Trigeminal Neuralgia, Home Sleep Study, UConcept, Polysomnography, HST, PSG, Trisomy, Loose broken baby tooth, eruption, Composite Porcelain, Facial Beauty Institute, Scaling Root Planing, Arestin, Saliva, Salivamax, Neutrasal, Dry Mouth, Biotene, Prevident, Muscle Relaxer, Allergy, Allergies, LPR, Laryngeal-pharyngeal Reflux, Inflammation, Uvula, Jaw Growth, tethered oral tissue, Grinding, Bruxism, Splint, Nightguard, Trauma, OralID, Schizophrenia, Depression, Heart Rate Variability, Rhinometer, Pharyngometer, Amalgam, Epworth, Lamberg, Debridement, Gingivitis, Gingival Graft, Xylitol, Hygiene, Hygienist, Emergency, Glo, UARS, Upper Airway Resistance Chronic Fatigue Syndrome, Baby Led Weaning, Breast Prostate Colon Cancer, Thumb sucking, Tongue Thrust, Nitric Oxide, Night Terrors, Sleep Walking Talking, Fibromyalgia, CFS, Obesity, OSA, AHI, Hypoxia, Alzheimer's, Dementia, REM, Panic Attack, Premature Low Birth Weight, Erectile Dysfunction, ED, SDB, Sleep Disordered Breathing, SIDS, RERAs, Gelb, Leptin, Grehlin, Mouth Breathing Taping, Nail biting, Asthma, Bipolar, Ear Infection Tubes Grommets, Dark Circles, GERD, Nasal Dilator Cones, Xlear, Breathe Right Strips, TOTs, Thyroid, Habit Corrector, Lisp, Pregnancy, Newborn, NICU, Vaccinations, Herpes, Cold Sores, Canker Sores, Posture, Inspire, Hypoglossal Nerve, Pharynx, Pharyngeal Pillars, HRV, Dystonia, Tremor, Parkinson's, Multiple Sclerosis, Dysautonomia, Circadian Rhythm, Tummy Time, Gummy Smile, Integrative Functional Dentistry, Slow Growth, Picky Eater, Sensory Issues, Texture Issues, Chewing, Gut Health, Probiotics, Immunity, Glymphatics, Lymphatic Drainage, Maxillary Mandibular Expansion, Distraction Osteogenesis, Sympathetic Autonomic Nervous System, Insomnia, Narcolepsy, Behavior, Sippy Cup, Pacifier, Stress, PANS, Tapping, Suicide, Screen Time, Blue Light, Sleep Hygiene, Infant Mortality, Aging, Breast Milk, Carotid Plaque, Atrial Natriuretic Peptide, ANP, scalloping, Concentration, Radiation, Chemotherapy, Anti-psychotic, Inhaler, Nebulizer, Otitis Media, Anesthesia, Sedation, Cerebrospinal Fluid, CSF, Upledger, Oxidative Stress, Weight Gain, Diaphragm, Forward Head, Dowager's Hump, Naps, Frenotomy, digital xrays, digital radiographs