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

Medical History

This form should be filled out for all patients of every age. It contains important questions regarding patient medical history. It should be filled out as completely as possible with all current medications and drug allergies listed when applicable.

DOWNLOAD MEDICAL HISTORY FORM
Adult
Registration

Child
Registration

HIPPA
Acknowledgement

HIPPA
Notice Form

Insurance
Authorization Form

Medical
History

Financial and
Insurance Information

Oral
Hygiene Tips

Request
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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