New patients seeing Dr. Redfern for treatment: Please print out and complete these forms. Bring the completed forms with you to your first appointment.
- Initial Visit Record.pdf
- Medical History.pdf
- TMJ Questionnaire.pdf
- Medical Records Release.pdf (If you want us to send copies of your records to another doctor or person)
- Privacy Practices.pdf
- Privacy Practices Acknowledgement.pdf
- Medicare Disclaimer.pdf
- Insurance Benefit Assignment.pdf (If you have insurance)
New Patients only receiving a CBCT scan:
* Form needs to be updated with new address.