Patient Forms

Here you will be able to download and print any forms you may need prior to your visit. Listed below are various forms that we use at Smile Stars and detailed instructions on each.

New Patient Forms allow parents to list a complete medical history, contact information, insurance and family information. We ask that you fill out each section to the best of your knowledge. Please make sure to sign all areas where a signature is required, as well as the bottom of the second page.

New_Patient_Form.pdf

The Financial Policy Form must be completed prior to a patient’s first visit. Please read this form thoroughly. If you have any questions regarding this form we would be happy to answer them.

Financial_Policy_Form.pdf

The Patient Update Form is usually competed once a year. This ensures that we stay up to date on all medical history changes and changes in contact information. Please complete one of these forms if you have moved within the last year, or changed your phone number and/or emergency contact information. This form can also be used to change the insurance information that we have on file.

Patient_Update_Form.pdf

The Notice of Privacy Practices Form should be filled out and completed after reading the Notice of Privacy Practice Notice.

Notice_of_Privacy_Practices.pdf

Notice_Privacy_Practices_Form.pdf

Our Confirmation Policy may be downloaded and printed. It is not necessary to bring this form to any appointment. You may be asked to sign a confirmation form prior to scheduling a treatment appointment.

Confirmation_Policy(1).pdf

Pre and Post Op Sedation Instructions can be downloaded and printed for your convenience. These detailed instructions should be reviewed before and after any sedation appointment. The Sedation Consent Form MUST be filled out prior to any Sedation Appointment. A staff member will be happy to review this form with you. Please read it thoroughly before signing.

Sedation_Information_and_Consent_Form.pdf


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Smile Stars Pediatric Dentistry

  • Baton Rouge Location - 10522 S. Glenstone Pl., Baton Rouge, LA 70810 Phone: 225-769-5377 Fax: 225-769-7910
  • Prairieville Location - 15097 Hwy. 73, Prairieville, LA 70769 Phone: 225-313-4245

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