Patient Forms

To help us prepare for your child’s visit, all patient forms must be completed at least two business days before the appointment. If forms are not completed by that time, the appointment may need to be rescheduled.

Our online forms allow us to review important information before your child arrives, including medical and dental history, insurance details, and any special needs or concerns you would like to share.

Why Your Child’s Full Health History Matters

Your child’s oral health is closely connected to overall health and well-being. Emotional, developmental, psychiatric, medical, and social factors can all influence how a child experiences dental care. Certain health conditions and medications may also affect saliva, cavity risk, gum health, healing, and treatment planning. Complete and accurate information helps us provide care as safely and appropriately as possible, including decisions related to anesthesia and referrals when needed.

How You Will Receive the Forms

New patient forms are sent by text message and email.

Email subject line: Banaji Pediatric Dental Specialists: Forms available to complete

Sender email address: noreply@fromyourdentalprovider.com

How to Complete the Forms

Open the link in the text or email, enter either your date of birth or your child’s date of birth, and follow the prompts to complete and submit the forms online. Once submitted, your information uploads directly into our system, so there is nothing to print.

Forms Included

Child Health History
Required for each child.

Patient Demographics
If you are completing forms for multiple children with the same household information, this form only needs to be completed in full once. For additional children, repeated information may be skipped and the form simply signed at the bottom.

Appointment and Financial Policy
Required for each patient.

General Consent
Required for each patient.