You can prepare for your visit with us by filling out forms beforehand. You may complete the forms online, or download them to complete in print and bring them to your appointment.

Adult New Patient Forms


Adult Health History Form

Patient Acquaintance Form

Financial Policy (One Per Family)

HIPAA Acknowledgement and Authorization

Request Records from a Previous Dentist

Child New Patient Forms


Child Health History Form

Patient Acquaintance Form

Financial Policy (One Per Family)

HIPAA Acknowledgement and Authorization

Request Records from a Previous Dentist

Contact Us

To learn more about what makes our team and practice so unique, or to schedule your first appointment, get in touch with Pittsford Family Dental and a member of our staff will be happy to get you started.

We can be reached by phone at 585-248-5250 or via email through our contact page.

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