New Patient Info - Barry Brace DMD & Associates 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's full name and preferred name in the designated fields. Ensure accuracy for identification purposes.
3. Fill in the date of birth, mailing address, and contact numbers. Select the appropriate gender option.
4. Provide information about the referring doctor and primary care physician, including their contact details.
5. Indicate if any family members have been seen before by selecting 'YES' or 'NO' and provide their names if applicable.
6. Complete the sections regarding parental information, including marital status and insurance details. Make sure to include all relevant phone numbers and email addresses.
7. Fill out emergency contact information for situations when you cannot be reached.
8. Provide pharmacy information for prescription needs, ensuring that all fields are filled accurately.
9. Review the child’s medical history section thoroughly, checking all relevant conditions and medications.
10. Finally, sign the consent for treatment and financial agreement sections to complete your submission.

Start filling out your New Patient Info form today using our platform for a seamless experience!