Patient Registration

New Patient Forms

If you decide that you would rather not have these forms provided online, simply call our office at Pickle Prosthodontics Phone Number 719-599-0670 and we will mail them to you instead. You may bring your completed forms with you at the time of your visit or fax them to 719-599-0613. As always, you may also fill out these forms in our office the day of your first visit.

These forms are provided in PDF format that allows you to view the form electronically on most computers. The freely available Adobe Acrobat Reader is required to view and print PDF files.

Please click below to preview and print the forms. There are two options – you can print the form with your local printer and fill it out by hand or you can fill out the form in our office.

New Patient Forms

Dental History Form

Welcome Form

HIPPA Notice of Privacy Practices

Hippa Acknowledgement
Please note that these forms require version 5.0 or greater of the Adobe Acrobat Reader. If you cannot “see” the forms correctly, click on the link above and download the latest version.

We Are Here to Help!

Contact us with any questions or to schedule an appointment to reclaim your smile today!

Call us: 719-599-0670