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Patient Forms


Reception desk at Tiny Teeth Pediatric Dentistry, that helps you with patient forms.To accelerate check-in and decrease your time in our waiting room, we make patient forms available online for you to complete prior to your appointment.

***Be sure to bring your insurance card the day of your appointment.***


New Patient Packet


Click here to complete the new patient forms online.

Release of Records


Click here to complete the release of records document.

IV Sedation Pre-Operative Agreement


Click here to complete the pre-op sedation agreement.

Adobe Document Cloud e-sign services comply with industry security standards, including HIPAA and PCI v3.0 used by the payment card industry. In addition, due to multiple protections and certifications, e-signatures are typically more secure than pen and ink signatures. For more information about Adobe Document Cloud Security, View this document.

Office hours

Mon–Thurs 8:00 a.m.–5:00 p.m.
Fri 7:00 a.m.–2:00 p.m.

Location

3933 N Maize Road
Wichita, KS 67101-9619

¡Hola!

Habla Español

Contact

Office (316) 202-9629
Fax (316) 202-0141

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Patient Forms Wichita KS • Tiny Teeth Pediatric Dentistry
At Tiny Teeth Pediatric Dentistry, we provide patient forms to accelerate check-in and decrease your time in our waiting room. Click to learn more.
Tiny Teeth Pediatric Dentistry, 3933 N. Maize Road, Suite 200 Wichita, KS 67101 - (316) 202-9629 - tinyteethwichita.com - 10/26/2021 - Page Terms:Pediatric Dentist Wichita KS - Pediatric Dentist Wichita KS -