Patient Center
New Patient Forms
Preparing for your first appointment
If you are a new patient, welcome to our office! We will do everything we can to make your experience here the best it can be.
The office of Jason J. Augustine D.D.S., M.S., P.C. is dedicated to the highest quality of Periodontal care in a relaxed and pleasant environment. If you are a new patient, welcome to our office! We will do everything we can to make your experience here the best it can be.
Please download and print our new patient forms and bring them completed to your first appointment.
- New Patient Form 2019 (opens a PDF file)
- Medical History form (opens a PDF file)
- Cancellation policy form (opens a PDF file)
- Consent to
Exam form (opens a PDF file) Acknowledgement to privacy practices form (opens a PDF file)Financial policy notice form (opens a PDF file)
We accept most major insurance programs.
Accepted Insurance List (opens a PDF file)
Please check with your insurance provider to make sure our office is In-Network with your plan.
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