New Patient Information

Forms For Your Visit With Our Port St. Lucie Dentist.

First off, we would like to welcome you to New Image Dentistry, your Treasure Coast family dentist! Here at New Image Dentistry, we offer our patients the very best dental care in town and provide a variety of dental services, including cosmetic and family dentistry, teeth whitening and more.

 

Dr. Talati and the team understand the importance of being comfortable and relaxed in a new environment. This page is comprised of important forms and information to assist us with your much-anticipated arrival!

How To Prepare

Below, you will find four different forms that are meant to give Dr. Talati and our staff a better understanding of each patient’s medical and dental history. We ask that you print these formsout, fill them out carefully, and bring them into the office during your first visit. This will allow us to begin your journey towards total dental health sooner than later!

Notice of Privacy Practices

Patient Financial Agreement

This form describes how health information about you may be used and disclosed. It also outlines how you can get access to this private information.
This form outlines our financial policies. As the form states, we accept cash, checks, major creditcards, and CareCredit.

New Patient Form

This form will inform us of the best way(s) to contact you. It also will allow you to provide general information about yourself and your insurance policy.

Medical History Form

This form is meant to give us an extensive understanding of your medical history. This is especially important because health problems that you may have, or medication that you may be taking, will directly affect the dentistry you receive.