Klugman Family Dental - Kenilworth, NJ
If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival. If you have a current list of medications; we also encourage our patients to bring a copy of this as well to their appointments. Patients who need to take premedication (antibiotic) prior to coming to the dental office should make the office aware while appointing. This can be done either through email or over the phone. If you are not sure if you require premedication prior to coming to the dental office please consult your physician. To read more about premedication please visit: Antibiotic Prophylaxis- American Dental Association
Thank you and please call our office if you have any questions.
Health History Form Page 1 of 2 (pdf form)
Health History form Page 2 of 2 (pdf form)
HIPPA form 1.docx (word document)
HIPAA form 2.docx (word document)
Covid Consent Form.docx (word document)
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