My Forever Smile
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  • A Smile Revolution
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  • About Us
  • Become a Provider

Insurance Authorization

This form should be signed by all patients who have dental insurance. This authorizes our office to release patient and procedure information to insurance on their behalf.

DOWNLOAD INSURANCE AUTHORIZATION FORM
Adult
Registration

Child
Registration

HIPPA
Acknowledgement

HIPPA
Notice Form

Insurance
Authorization Form

Medical
History

Financial and
Insurance Information

Oral
Hygiene Tips

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an Appointment

About Us

At My Forever Smile, we make straight teeth and beautiful smiles affordable and we do it efficiently to save you time! We use an effective method that corrects dental issues. A beautiful smile is within your reach.

  • Home
  • The Smart Choice
  • A Smile Revolution
  • Find a Provider
  • About Us
  • Become a Provider

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