Pinetree Dental Care

Your family dentist in Midlothian, VA

New Patient Forms

New Patient Forms

We are happy to offer our patient forms online. Please feel free to print and fill them out at your convenience before your visit.


New Patient Registration

Please download, print and complete this form before your first dental appointment.

Download New Patient Registration


Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information.

Download Notice of Privacy Practices


HIPAA Form

Please download, print and complete this form before your first dental appointment. This form confirms that you read our Notice of Privacy Practices.

Download HIPAA Form


Financial Agreement Form

Please download, print and complete this form before your first dental appointment.

Download Financial Agreement Form


Cancellation Form

Please download, print and complete this form before your first dental appointment.

Download Cancellation Form


Dismissal Policy Form

Please download, print and complete this form before your first dental appointment.

Download Dismissal Policy Form


If you are unable to view the pdf files, please click on the icon below to download and install Adobe Reader:

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