Concord Family Dental New Patient Forms

Thank you for choosing our dentist office in Algiers. We'll get you started online so you won't have to spend any time filling out forms in our dentist office. Below you'll find the forms you need for your first dental visit with Dr. Quartano. You'll also learn what to expect when you come in for your appointment. If you still have any questions, don't hesitate to contact us, or call Concord Family Dental of New Orleans. We're here to answer your questions and make sure your dental experience is the best yet!

Please complete the following information and bring these forms to your appointment or e-mail the forms to our dentist office in Algiers. The HIPAA Acknowledgement and Authorization for PHI Disclosure form acknowledges that you have received the form. It also provides instructions to Concord Family Dental of New Orleans, about with whom we may disclose information regarding your treatment--if anyone.

Day of Your Appointment

Please arrive early. We recommend you arrive 5-10 minutes before your scheduled appointment. We'll make sure you have all your paperwork completed so you can start your appointment on time! Prior to your appointment, if you haven't already e-mailed the forms above to our Algiers dental office, please bring the forms with you to your dental 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