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PATIENT FORMS
In order to better treat you, we kindly ask that you authorize a release of your previous dental records. Please download and sign or release form here:
As required by law, our office adheres to written policies and procedures to protect the privacy of information about you that we create, receive or maintain. Your answers are for our records only and will be kept confidential subject to applicable laws. Please note that you will be asked some questions about your responses to the attached questionnaire and there may be additional questions concerning your health. This information is vital to allow us to provide appropriate care for you. This office does not use this information to discriminate.
Please download and complete the Health History Form here:
Should a child be unaccompanied by a parent or legal guardian at the time of their treatment, we kindly ask that the attached consent form be brought with them to our office. This additional information will assist in treatment if it can be furnished with consent but is not required.
Please download and complete the Consent to Treat a Minor Form here:
This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully. The privacy of your health information is important to us.
Please review and sign our missed appoinment policy here:
Please review and sign our Dental Sleep Questionnaire here:
At Buehler Family Dental, we accept many insurance plans. The following are our main participants:
Aetna
Cigna
Guardian
Blue Cross
Principal
MetLife
For all other insurance providers, please inquire within to confirm other participants.
Buehler Family Dental is open and following all necessary guidelines.
Your health is important to us. We have specific guidelines in place to keep our team and patients safe.
