We are so pleased to offer our patients the ability to utilize our HIPAA compliant electronic health records submission portal so that you can provide us the the most detailed, current and accurate information from the convenience of your home.
Please complete the applicable form for your child’s upcoming visit by clicking the link below.
Infant Lip tie/Tongue tie Consult – To be completed for babies less than age 1 year of age coming to us for feeding difficulties.
Child Lip tie/Tongue tie Consult – To be completed for children above age 1 year coming to us for Lip tie and/or Tongue tie related difficulties – speech, feeding, sleep, behavioral or dental concerns..
New Dental Patient Child Form – To be completed for children above age 1 year and coming to us for any of the following scenarios: 1) First visit to Smile Wonders, 2) Previous infant patients that are now returning for their age 1 dental visit, 3) Patients that are returning after having transferred care to another provider, or 4) Patients that have not been to our practice for more than 3 years.
Additional Child New Patient Form – To be completed for any additional children that are joining our family as dental patients. Please complete this form only if other demographic and financial/insurance information is the same as another child that is already a current patient at Smile Wonders.
Annual Updates – Current Patients – To be completed annually by ALL current patients to keep the medical and demographic information up-to-date.
Pro Tip #1 If you are completing these forms prior to having an appointment already scheduled, please use the Child’s first name, Last name and use next business day for appointment date.
Pro Tip #2 Remember to close out the window after submitting each child’s form.