- Patient Information, HIPAA Consent & Office Policies (PDF to print)
The main new-patient packet. Print it, fill it in at home and bring it to your first visit.
- Sleep History & Exam (fill in online)
For a consultation about snoring, sleep apnea or an oral sleep appliance.
- Oral Surgery (fill in online)
For a visit about an extraction, wisdom teeth or another surgical procedure.
- Periodontal (fill in online)
For an evaluation or treatment of gum disease, including Perio Protect.
Which forms does a new patient need?
Every new patient needs the patient information, HIPAA consent and office policy packet. It is a PDF: download it, print it, complete it at home and bring it with you, along with your insurance card and a list of your medications.
The packet gives Dr. Prane your health and dental history before she meets you, and it records your consent to how your information is handled. Completing it ahead of time means more of your appointment goes to your mouth and less to a clipboard.
When do you need one of the online forms?
Only when your visit is about one of three specific things. The online forms gather the extra history each kind of care needs, and you complete them in your browser without printing anything.
The sleep history and exam form is for a consultation about snoring or sleep apnea treatment. The oral surgery form is for an extraction or other surgical visit. The periodontal form is for gum disease evaluation or treatment. If you aren’t sure which applies, call (618) 624-2800 and ask when you book.
What is the HIPAA consent form for?
It confirms that you’ve been told how the practice may use and share your health information. HIPAA is the federal law that protects the privacy of health records, and every dental office is required to give patients a notice of its privacy practices.
Signing it doesn’t give away your privacy. It acknowledges the notice, and it lets the office handle routine matters such as billing your insurance. Ask the front desk if you’d like a copy of the full notice.
What if you can’t print or finish the forms?
Call the office before your visit and let us know. The front desk can tell you how best to complete the packet, and the team can help with anything that isn’t clear. There’s no need to postpone a visit over paperwork. If a question on a form doesn’t apply to you, or you aren’t sure how to answer it, leave a note beside it and bring the question to your appointment.
Once your forms are ready, request your appointment and the scheduling coordinator will call to confirm a time.