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.

New Patient Form.pdf

The Financial Policy portion 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.

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

Notice Privacy Practices.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 Consent Form.pdf
Sedation Packet.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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