Forms

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:

• Medical History.pdf

• TMJ Patient History.pdf