Patient Forms Please print and fill out each one of the listed forms and bring it to your initial appointment. New Patient Forms Dental History Medical History Medication List Insurance Information HIPAA Forms Notice of Privacy Practice Acknowledgement of Receipt Consent for Release of Personal Health Information Consent for Implant Surgery Consent for Anesthesia Contact Us Crown Point Location 1549 South Court St., Ste. C Crown Point, IN 46307 (219) 226-9380 Michigan City Location 2146 N. Karwick Road Michigan City, IN 46360 (219) 878-1280 Features Call 1-877-526-4547 now to receive this free book! Search for: