Patient Forms

To help you prepare for your visit at Arlington Dentistry, we have provided our patient forms online. Simply complete these forms before your appointment in order to save some time when you visit us. If you have any questions about our forms or your first visit with our dentist, Dr. Withrow, we invite you to call us at your convenience. We look forward to taking care of you!

New Patient Questionnaire

Health Insurance Portability and Accountability Act of 1996

Disclosure and Access to Medical Information

Authorization for Release of Identifying Health Information

Consent for Services