Forms

New Patient Forms

If you would like to complete the required forms prior to your child’s appointment you can download the forms below. Please complete the forms and bring it with you to the appointment.

Use link to download forms here

If your child is under the care of a specialist for any medical, behavioral or emotional condition please complete the following form:

Special Care Coordination

Referring Doctors

If you are a referring doctor, please complete the following form and send to smiles@superheroteeth.com. Please make sure to include patient name, DOB, and contact information.

Referral Form