Registration Information

The following forms are made available for your convenience and can be printed out and completed prior to your appointment at Whatley Endodontics.  Please bring the completed forms to your appointment.  Otherwise these forms will be provided upon your arrival and you will need to arrive 20 minutes prior to your scheduled appointment time. 

• PATIENT REGISTRATION
• PATIENT HEALTH HISTORY
• ONLINE PATIENT REGISTRATION PORTAL

 

The following document, Notice of Privacy Practices need to be brought to your appointment but you should read over this prior to signing the HIPPA acknowledgement form.

• Notice of Privacy Practices

The following form, Consent to Release General Health Record, is only needed if you would like copies of your health records.

• Consent to Release General Health
• Map Directions