Patient forms,
ahead of time.
Complete your intake digitally before your appointment. We use your visit for dentistry, not paperwork.
When you book a new-patient visit, you receive a secure link to our digital intake (Modento). It takes about 10 minutes and covers registration, medical history, consent, and insurance information if you have any. Completing it in advance means your appointment starts on time and your full 90 minutes goes to the consult.
The forms,
plainly.
Patient registration. Basic contact information, emergency contact, preferred method of communication.
Medical history. Current medications, allergies, relevant medical conditions, surgical history. We ask in detail because certain medications affect dental treatment planning.
Dental history. Your most recent dental visit, prior treatments, current concerns, what you would like to address.
Insurance information. If you have dental insurance and want our help submitting out-of-network claims, we collect carrier name and member ID. We do not bill insurance directly.
HIPAA consent. Standard acknowledgment of our notice of privacy practices. See Notice of Privacy Practices.
Check your inbox.
If you booked your appointment, the secure intake link is in your confirmation email from Modento (look for sender @modento.io). If you cannot find it, call us at (941) 927-8287 and we will resend it.
Not yet booked? and the intake link will arrive with your confirmation.