Patient Forms

Patient Forms
Please print and fill out these forms so we can expedite your first visit:

  • ADA COVID SCREENING FORM https://securehealthform.net/webform/drtoddkbaumddsmi&formid=NjMzNTM=   
  • MEDICAL HISTORY https://securehealthform.net/medicalwebform/drtoddkbaumddsmi  
  • HIPPA FORM https://securehealthform.net/webform/drtoddkbaumddsmi&formid=NjkyNDk=
  • AUTHORIZATION  TO RELEASE DENTAL RECORDS https://securehealthform.net/webform/drtoddkbaumddsmi&formid=NjkzMjI=
  • FINANCIAL POLICY https://securehealthform.net/webform/drtoddkbaumddsmi&formid=NjMzNTc=
  • CONSENTMENT TO TREAT MINOR https://securehealthform.net/webform/drtoddkbaumddsmi&formid=NjkzMjU=

In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.