Patient Information Form

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Patient Information

    Patient Info

  • I hereby give my consent to Dr. Brandon Bailey and staff to examine, take x-rays, photographs, and any other diagnostic aids deemed appropriate by the doctor. I request and authorize Dr. Brandon to provide comprehensive dental treatment, such treatment may include medications, local anesthetics, analgesia, and behavior management techniques that may be necessary to correct oral deficiency, abnormality, infection, or disease. I understand that it is my responsibility to advise and notify Dr. Brandon of any changes in information contained on this form.
  • Insurance Information

  • Medical History

  • Dental History

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