Forms


As a service to our patients, we have provided below the various forms that you'll need during your Endodontic treatment. If you would rather complete our patient forms before you arrive to our office, please feel free to download these forms to your computer (they are in PDF format and can be read with Acrobat Reader, a free program), print them out, and fill them out at your leisure. When you arrive, please hand these forms to someone at the front desk and they'll begin the process of getting you registered for treatment.

Patient Registration

Our Patient Registration form provides us with all of your personal (non-medical) information. Please click here to download the form.


Medical History

Our Medical Information sheet will help us provide you with the best possible care. Please click here to download the form.


Consent to Endodontic Therapy

The consent form allows us to perform endodontic procedures while you are in our care. Please click here to download the form.


Now that Root Canal Treatment is Complete

This form will give you helpful information for what to do after treatment. Please click here to download the form.


Now that Root Canal Treatment is Complete

This form will give you helpful after-treatment home care information. Please click here to download the form.


Signature on File

This form acknowledges financial and insurance obligations on your behalf. Please click here to download the form.


Signature on File

This form acknowledges your reciept of our notice of privacy practices. Please click here to download the form.

Quick Links


FAQ
Our FAQ addresses the questions we most often receive from patients.
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ABOUT DR. GEBBIA
Dr. Gebbia has been a practicing Endodontist for almost 30 years. This section will help you learn more about Dr. Gebbia and his history.
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DIRECTIONS
If you'd like directions to the office, we have links to Google Maps to help you get here quickly and easily.
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