Thomas Quickstad DDS Dentistry for All Ages

The following forms are available, we will be adding and improving these over time.

Transfer Of Records

I, __________________________, hereby authorize the office of

_____________________________
(name)
_____________________________
(address)

_____________________________
(phone)

to transfer dental records, including x-rays, written chart notes, periodontal charting, referral forms, and any other related forms or paperwork for the following family members:

Name Birthdate
_______________________________
_______________________________
_______________________________
_______________________________

HIPPA PRIVACY FORM
Notice Of Privacy Practices
Purpose: This form, Notice of Privacy Practices, presents the information that federal law requires us to give our patients regarding our privacy practices.