Patient Information Form

 

Please feel free to download and print the Patient Registration Form listed below before coming to our office. You may either bring it with you to your visit or fax them to us before your appointment to (205) 414-8244. To view this form, you will need Adobe Reader. You may download Adobe Reader for free by visiting http://get.adobe.com/reader/.

 

Please click below:

 

 

 

 

 

 

 

 

 

 

 

Download and PRINT the new patient form. Please bring the completed form when you visit our office.

 

Click here to read HIPAA policy

 

BALLARD ENDODONTICS • 1771 INDEPENDENCE CT. • SUITE 4 • VESTAVIA HILLS, AL • 35216 • (205) 414.1499 P • (205) 414.8244 F