Patient Forms

Save time at your appointment by completing your paperwork online before you arrive. Our secure digital forms allow you to enter your health history, insurance information, and consent documents from the comfort of home. This gives our team time to review your information in advance and prepare for a productive first visit.

New Patient Registration

If this is your first visit to the practice of Dr. R. David Brumbaugh, please complete the new patient registration form. It includes sections for personal information, medical and dental history, current medications, and insurance details.

Complete New Patient Form

Referral Form

Were you referred to our practice by another dentist or physician? Please let us know so we can coordinate care and send reports back to your referring provider.

Complete Referral Form

What Information You Will Need

To complete the forms efficiently, have the following ready:

• Your full legal name and date of birth
• Current home address and contact information
• Dental insurance card (subscriber ID, group number, carrier name)
• List of current medications and dosages
• Medical conditions or allergies relevant to dental treatment
• Name and contact information of your primary care physician
• Emergency contact information

Privacy and Security

Your information is transmitted securely and stored in compliance with HIPAA regulations. We never share your personal health information without your written consent except as required by law or for treatment coordination with referring providers.

Prefer to Complete Forms in the Office?

If you prefer paper forms, simply arrive 15 minutes before your scheduled appointment time and our front desk team will provide the necessary paperwork. Completing forms online in advance is optional but recommended to minimize wait time.

Questions About Your First Visit?

If you have questions about what to expect, what to bring, or how to prepare, call 214-369-5159 or contact us online. Our team is happy to walk you through the process.