First Visit

Patient Registration Form

Medical History

Dental History

HIPAA (Privacy Policy)

Photo Consent Form

Your first visit to our office establishes a vital foundation for our relationship with you and is designed for your to become better acquainted with the care we provide as well as introduce you to our outgoing team of professionals.

At your initial preventive care visit, we will review your medical and dental histories and evaluate your oral health. This means a comprehensive examination, with both an intra-oral and extra-oral exam as well as necessary x-rays, measuring the health of your gum tissue, an oral cancer screening and a review of home care tailored to your specific dental needs.  Dr. Chaudhry will use this date to create your best treatment options.

For patients being seen due to pain, swelling or another dental emergency, Dr. Chaudhry may start or complete your treatment based on clinical exam findings and diagnosis.

Should you have a complex medical history or complex treatment plan it may be necessary to review your treatment options and agree upon a course of dental care  and then re-appointment accordingly. 

With the link between the health of your mouth and your overall health now firmly established, please assist us in providing you with the best possible care by having the following information with you for your initial visit:

  • Any x-rays taken by your former dental provider, if applicable. This gives Dr. Chaudhry a baseline for your dental care.
  • A list of medications you are presently taking.  We now know that many medications can affect the health of your mouth and may create an environment that promotes decay.
  • For those with dental benefits, please have your current dental plan ID card, or the Group Name, Group Number, ID number, and Insured’s date of birth as well as Employer name. This will allow us to obtain your benefit information in a timely manner and prevent  claim delays.

IMPORTANT: All patients under the age of 18 must be accompanied by a parent or guardian.

Please let us know if you have a medical condition that may be of concern prior to treatment (i.e., Diabetes, High Blood Pressure, Artificial Heart Valves, Artificial Joints, Rheumatic or Scarlet Fever, etc.) or if you are currently taking any medication (i.e., heart medications, aspirin, anticoagulant therapy, etc.).


If your dentist has taken x-rays within the last 24 months, please request that they forward a diagnostic-quality copy to our office via email.  Send all x-rays to [email protected]  Dr. Chaudhry will review the radiographs that are forwarded, and should supplemental x-rays be needed, they can be taken at your first appointment.