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Alaa Moustafa, DDS, MS
Board Certified Prosthodontist
Restorative and Implant Dentistry

Patient Forms

Make Your First Visit Easy!

Save 20 minutes at your fist visit by bringing in your completed forms to your 1st appointment!

We have made our new patient forms available on this website for your convenience!  You can print out and complete our new patient forms at home before visiting our office. 

If you have any problems with the forms, simply call our office and we will gladly send or fax them to you.   We look forward to meeting you and helping you with your dental needs!

The forms here are Adobe Acrobat files. If you don't have Adobe already, you'll need the free Acrobat Reader to view and print them.  Free download below.

New Patient Information Form

Medical History Form-English

Medical History Form-Spanish

Dental Materials Fact Sheet - English

Dental Materials Fact Sheet - Spanish

HIPPA Notice of Privacy Practices

 


Adobe Acrobat Reader is a free download.

Download Adobe Acrobat Reader

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.
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