PATIENT INFORMATION
Patient Forms
Please click the corresponding (package) link below to fill out your new patient information form.
New Patient Forms
Only fill out your appointment's specific package.
Please fill out forms using a computer or tablet. Forms completed on a mobile device may not be received.
Our system requires for each form to have the patient's name at the beginning of the form.
New Patient Forms
Complete these forms for your child's first visit to Green Apple Pediatric Dentistry.
Open FormNewborn Frenectomy Forms
Specific forms for infants requiring tongue-tie or lip-tie release procedures.
Open FormChild Frenectomy Forms
Forms for older children needing frenectomy procedures.
Open FormOther Useful Forms
Non-Parent Consent Form
For when someone other than the parent brings the child to the appointment.
Open FormDental Records Release
Request to transfer dental records from another provider.
Open FormFrenectomy Referral Form
For referring healthcare providers sending patients for frenectomy procedures.
Open FormReferral Forms
Dental Professional Frenectomy Referral Form
Myofunctional Therapist Frenectomy Referral Form
Pediatrician Frenectomy Referral Form
Speech Therapist Frenectomy Referral Form
Lactation Consultant Frenectomy Referral Form Coming soon — please call our office for this form in the meantime.
Questions about referrals? Call our office at 512-917-4550