Download our patient forms
Fill these out at home and bring them to your first visit. Saves time at the front desk and lets us focus on your care. If you have trouble downloading or filling these out, call (713) 322-7474. We can mail you printed copies.
Available forms
New patient intake form
Personal details, emergency contact, payment authorization. Fill out before your first visit to save time at the front desk.
Available shortly. Call us for a copyMedical history form
Current medications, allergies, conditions, prior surgeries. Critical for safe treatment planning, especially around sedation.
Available shortly. Call us for a copyHIPAA privacy acknowledgment
Required for all new patients. Acknowledges receipt of our Notice of Privacy Practices.
Available shortly. Call us for a copyInsurance assignment of benefits
Authorizes Omega Dental to bill your insurance directly. Saves you from paying out of pocket and waiting for reimbursement.
Available shortly. Call us for a copyFinancial policy + consent
Our written payment and financing policy. Covers what's expected at the visit, financing options, and missed-appointment fees.
Available shortly. Call us for a copyPediatric patient form
For patients under 18. Parent/guardian information, school, emergency contacts, child's medical history.
Available shortly. Call us for a copyForms are provided as fillable PDFs. Adobe Acrobat Reader or any modern web browser (Safari, Chrome, Firefox, Edge) can fill them out. No software purchase required.
Questions about the forms?
If anything on the forms is unclear, or you'd prefer to fill them out in person:
- Call us: (713) 322-7474, Mon-Fri 9 AM - 5 PM
- Visit: 106 W Gray St, Houston, TX 77019. Front desk can print copies and walk you through any section.
For new patients, we recommend arriving 10 minutes early on your first visit even if you've filled out the forms. This gives time to verify insurance and answer any last questions.
Haven't booked yet?
New patient slots are usually available within the week.