Patient forms

New Patient forms- Damascus location

New Patient forms- Frederick location

Our new patient registration form can be completed online saving you time. Once you complete them, you will be redirected to the main page.

COVID 19 screening form- Damascus Location

COVID 19 screening form – Frederick Location

Per CDC/MSDA/ADA guidelines,  to protect our patients & our staff we require all our patient/parents/guardians/caregivers accompanying the child to complete the screening form.

Medical History form

Damascus Medical/Dental History form

Frederick Medical/Dental History form

Below as a PDF file. You can print, fill and bring them along.

Medical History Form

If a Parent or Legal Guardian is not going to accompany the child, please print below form, sign, date, witness it and send along with caregiver to clinic on day of appointment.

NSKD non parent consent form only

Below are copies of our policies, acknowledgments and consents.

  1. Notice of Privacy Practices
  2. Notice of Non-discrimination
  3. Financial & Office Policies
  4. Billing of Non-covered services 
  5. Informed consent for treatment
  6. Image Release form
  7. Please read and understand the pre & post op instructions for moderate sedation.

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