toggle menu ANNOUNCEMENTWe are open and seeing patients. This includes regular visits for exams, cleanings, and x-rays. Find an office near you. If you have an appointment soon, please read our FAQ to learn about new processes for your appointment and extra safety precautions we are taking. New Patients Midwest Dental > Patient Information > New Patients Request an Appointment New Patient Forms Day of Your Appointment New Patient Forms Thank you for choosing Midwest Dental. For your convenience, this section includes forms you'll need during your first visit, as well as what to expect when you come in for your appointment. If you still have any questions about your upcoming visit, please call your Midwest Dental office. We're here to help. Please complete the following information. Be sure to bring these forms to your first appointment. The HIPAA Acknowledgement and Authorization for PHI Disclosure form acknowledges that you have received the form. It also provides instructions to Midwest Dental about who, if anyone, we may disclose information about your treatment. ADULT PATIENT HEALTH HISTORY FORM Download Form CHILD PATIENT HEALTH HISTORY FORM Download Form HIPAA ACKNOWLEDGEMENT AND AUTHORIZATION Download Form MIDWEST DENTAL FINANCIAL POLICY Please read, agree to, and sign our financial policy prior to any treatment. Download Form PRE-MEDICATION REQUIREMENTS Patients with certain medical conditions may need to take medication before seeing the dentist. Read Form ABOUT OUR PRIVACY PRACTICES We are required to provide you with information about our procedures to safeguard your personal information. Read Form Day of Your Appointment Please arrive 15 minutes before your scheduled appointment. This will allow us to finish any paperwork and stay on schedule with your appointment. Please bring the following items with you to your first appointment: Patient Information Form Dental Insurance Card (If applicable) Identification such as Driver's license, military ID or state ID Patient Health History Form HIPAA Consent Form Patient Authorization Form Home Locations Care & Services For Patients Careers Bill Pay © 2010-2021 Midwest Dental Language assistance available: Amharic | Arabic | Chinese | Cushite (Oromo) | French | German | Hindi | Hmong | Karen | Korean | Laotian | Mon-Khmer, Cambodian | Russian | Serbo-Croatian | Spanish | Tagalog | Thai | Vietnamese We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or sex. You may access the Nondiscrimination and Accessibility notice here.