At ABC123 Pediatric Dentistry, your children’s smiles are important to us! We keep kids happy and healthy by focusing on providing exceptional service to promote bigger, brighter smiles. Our goal is to provide a pleasant and positive experience for both you and your children while focusing on your specific needs.
We understand how intimidating visiting a dentist for the first time can be for children. For this reason, we strive to have a welcoming and comfortable office for you and your children.
Prior to your children’s first visit, feel free to ask anyone on our staff any questions you have so they can answer them and help alleviate any concerns you have about coming to see the dentist.
Our entire staff is here for you and your children during their appointment. We strive to have a welcoming and comfortable office for you and your children.
We will do everything we can to ensure your children have a good visit. We are here to answer any questions or alleviate any concerns before your children even sees the dentist!
Patient Forms
New Patient Packet (English)
New patient form – Click here to submit online
Additional child – Click here to submit online
HIPPA – Click here to submit online
Financial Policy – Click here to submit online
New Patient Packet (Spanish)
New patient form – Click here to submit online
Additional Child – Click here to submit online
HIPPA – Click here to submit online
Financial Policy – Fill Out Online
Recare Hygiene Packet (English)
Hygiene Services Informed Consent – Fill Out Online
HIPPA – Click here to submit online
Financial Policy – Click here to submit online
Dental Treatment Forms (English)
Nitrous Overview – Download PDF
Nitrous Informed Consent – Click here to submit online
Oral Sedation Informed Consent – Click here to submit online
Dental Treatment Forms (Spanish)
Oral Sedation Informed Consent – Download PDF
Miscellaneous Forms (English)
Pre-Screening COVID-19 Questionnaire – Fill Out Online
Silver Diamine Fluoride Consent – Fill Out Online
Letter of Parental Consent – Click here to submit online
PDF Downloadable Forms
New Patient Form (English) – Download PDF
New Patient Form (Spanish) – Download PDF
Letter of Parental Consent – Download PDF
Hygiene Services Informed Consent – Download PDF
Financial Policy – Download PDF
Dental Treatment Informed Consent – Download PDF
Silver Diamine Fluoride Informed Consent – Download PDF
Pre-Screening Form COVID-19 – Download PDF
Oral Sedation Informed Consent – Download PDF
Nitrous Oxide Overview – Download PDF
Nitrous Oxide Informed Consent – Download PDF
If you have any questions or would like to set up an appointment, feel free to contact us today at (713) 436-8988.