Manassas VA Dentist Office Patient Consent Forms

Welcome to Manassas Smiles! We hope to make your first visit to our dentist office as stress-free as possible. To help your first visit run smoothly, we offer the convenience of patient consent forms. Please fill out your forms prior to your first visit.

• Tooth Extraction Consent – English

• X-Ray Release Form

• X-Ray Refusal Form

• Patient Registraion Form

• Patient Medical Update

• HIPAA Consent

• Tooth Extraction Consent Spanish

• Smiles Club Insurance

• Oral ID Consent

• Root Canal Consent

• Periodontal Refusal Form

• COVID-19 Questionnaire