Patient Forms

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Copper Canyon Family Dentistry Patient Forms

In the areas and links below you can access all of the forms that we may require you to fill out and submit to us. These forms are in pdf format and must be printed, filled out, then given to us when you visit us.

 

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Financial Responsibility Contract

Click Here for Financial Responsibility Contract (pdf)

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New Patient Acknowledgement of Privacy of Practices

Click Here for New Patient Acknowledgement of Privacy Practices (pdf)

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Patient Notice of Privacy of Practices

Click Here for Notice of Privacy Practices (pdf)