Forms

Get a head start on your initial visit by completing the Patient Registration and Dental & Medical History forms. Download the attached documents, enter the required information, and email the forms to our office two days prior to your appointment so that your doctor and her team can better prepare for your visit.

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Patient Registration (2014) (*Note for Mac Users: Please complete and email. Do not print)
Dental History (2014)
Medical History (2014)
HIPAA Sleep Apnea Assessment
TMJ Scale Form

Instructions: In order to save your completed documents, click “File” and select “Save As.” Incorporate your last name into the “File name” and click “Save.” Email the forms back to info@cournotleedds.com as an attachment. We request that you sign the hard copy at check-in.