Your Desired Smile Patient Forms

 Referral forms

Step 1: Select Form

  • To select a form below, right click and select “Save As…” to save the desired form to your computer. Open the document in Adobe Reader to fill in the fields, and submit the form electronically.
DL Acknowledgement of Receipt of Notice Privacy Practice
DL Financial & Office Policies
DL Patient Registration
DL Medical History

Step 2: Complete Form, either:

  • Print forms and fill out. Bring these to the office for your scheduled appointment.
  • Or, the preferable method, complete the PDF and save the document to upload. See Step 3.


Step 3: Submit Form

  • If you choose the preferable method, please submit the forms below. If you choose to print and fill out the form by hand then please bring with you when you come for your appointment.


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