Scanlan Family Dentistry Patient Forms
Complete the Right Forms Before Your Visit
Download the current Scanlan Family Dentistry registration forms, financial policies, privacy notice, records-transfer authorization, and orthodontic guidelines directly from the live website.
Choose Your Form
Use Current Forms and Policies
Completing requested forms before arrival gives the care team time to prepare and keeps more of the appointment focused on your health, concerns, and care. Choose the adult form when the patient is completing their own history or the child form when a parent or legal guardian is registering a minor.
The links below point directly to the current PDF files on the live Scanlan Family Dentistry website. Download the document, complete it as directed, and bring or return it using the method provided by the care team. Completed forms may be emailed to info@scanlanfamilydentistry.com through the practice's protected email system or returned as directed by the care team. Do not submit medical history, dental records, insurance information, or other protected health information through a general website contact form.
New Patient Registration
Choose the form for the person receiving care. Each link opens the current PDF on the live Scanlan Family Dentistry website.
Adult New Patient Form
For an adult patient completing personal, dental, medical, medication, insurance, and authorization information.
Download Current Form →Child New Patient Form
For a parent or legal guardian registering a minor and providing the child's dental, developmental, medical, medication, and insurance information.
Download Current Form →How to Complete and Return Forms
Each step is explained before you are asked to move forward.
1) Choose the Correct Registration Form
Select the adult or child form based on the person receiving care.
2) Download and Review the Entire PDF
Save or open the current document and review every page before completing it.
3) Complete All Requested Information
Provide accurate contact, health, dental, medication, allergy, insurance, and authorization details. Use an additional list when the form does not provide enough room.
4) Sign Where Required
The patient or authorized parent or legal guardian should complete the signature and date fields that apply.
5) Return the Form Securely
Bring the completed form or email it to info@scanlanfamilydentistry.com through the practice's protected email system. Do not attach sensitive forms to a general website contact form.
Privacy, Records, and Continuing Responsibilities
The Notice of Privacy Practices explains how protected health information may be used and disclosed and describes patient rights. The photo-release and orthodontic-transfer document explains permissions for clinical photographs and terms for transferring orthodontic treatment.
Orthodontic retention is an ongoing patient responsibility. The retention guide explains wear, cleaning, storage, and what to do when a retainer is lost or damaged.
Policies, Privacy, Records, and Retention
Use the links and preparation details that apply to your care.
General Dental Financial Policy
Payment, appointment-reservation, insurance-estimate, and claim-filing terms.
Download Current PDF →Orthodontic Financial Policy
Financial terms specific to Invisalign and orthodontic treatment.
Download Current PDF →HIPAA Notice of Privacy Practices
How protected health information may be used and disclosed and the rights available to patients.
Download Current PDF →Photo Release and Orthodontic Transfer
Photographic-records release and orthodontic treatment-transfer terms.
Download Current PDF →Orthodontic Retention Guidelines
Patient responsibilities for retainer wear, care, storage, loss, damage, and long-term alignment.
Download Current PDF →Form Questions
Which new-patient form should I use?
Adults completing their own history should use the Adult New Patient Form. A parent or legal guardian registering a minor should use the Child New Patient Form.
Can I complete the form electronically?
PDF behavior depends on the browser and software you use. If a field cannot be saved reliably, print the form and complete it clearly by hand.
Can I email a completed form?
Yes. Completed forms may be emailed to info@scanlanfamilydentistry.com. For questions about your forms, call or text (919) 977-1870. The practice email system uses Paubox encryption and Ironscales email-threat protection and is configured for HIPAA-compliant communication in both directions. Do not submit completed forms through a general website contact form. Review our website privacy policy.
What if I need more room for medications or health information?
Attach a separate complete list and include the patient's name so the information can be matched to the correct record.
Do I need to read the financial policy before treatment?
Yes. Review the current policy that applies to your care and call or text the team at (919) 977-1870 about anything you do not understand before treatment begins.
Who should sign a child's form?
The child's parent or legal guardian should complete the required authorizations and signature fields.
Let’s Plan Your Visit
Tell us a little about the visit you need. Our care team will answer your questions and help you schedule with Dr. Scanlan. If a tooth is hurting or your concern is urgent, please call the office.