General Patient Forms - Great Expressions Dental Centers 2025

1. Click ‘Get Form’ to open the General Patient Forms in the editor.
2. Begin by entering your personal information, including your last name, first name, and initial. Specify how you wish to be addressed and provide your date of birth.
3. Fill in your address details, including city, state, and zip code. Ensure you include all telephone numbers (mobile, work, home) and your email address.
4. Indicate how you heard about the practice. This helps us understand our outreach effectiveness.
5. Complete the insurance information section by providing details for both primary and secondary insurance if applicable. Include subscriber names, IDs, dates of birth, relationships to subscribers, and employer information.
6. If filling out for a minor, complete the responsible party section with their details.
7. Provide an emergency contact's information including their name and phone number.
8. Review the authorization section carefully before signing. Ensure you understand consent for treatment and electronic communications.
9. Finally, sign and date the form at the bottom to confirm that all provided information is accurate.

Start filling out your General Patient Forms today using our platform for a seamless experience!