Forms


Thank you for choosing North Point Pediatric Dentistry. Please follow the link below to a secure portal to complete, review and sign all necessary documents. By law, we are required to have this information on file in order to treat your child/children. Please complete all necessary forms and consent documents in their entirety 2 to 7 days in advance of your appointment time.

All documentation must be completed by a parent or court appointed legal guardian, no exceptions. Failure to complete all necessary forms may require information to be completed once again, in office. If you have any questions, please contact our office and we will be happy to help you.

PLEASE NOTE: If you are not filing insurance with Indiana Medicaid, please leave the last form blank but sign where indicated. It will not be attached to your account but it is necessary to submit the package of forms electronically.

Forms for Legal Guardians

Note to Parents & Legal Guardians:

If you, as parent or legal guardian, need to authorize someone to bring your child to an appointment or make any decisions regarding care, please fill out this form below. Notice, you must be parent or legal guardian to fill out this form.

(Spanish) Si usted, como padre o tutor legal, necesita autorizar a alguien mas a llevar a su hijo/a a una cita o tomar cualquier decisión con respecto a la atención dental, completa este forma que sigue. Aviso, debe ser padre o tutor legal para completar este forma.

Update Patient Information

If you are an existing patient of our practice and you have been instructed to update patient information, please click on the link below:

Existing Spanish Patients

If you are an existing Spanish speaking patient of our practice and you have been instructed to update patient information, please click on the link below: