Patient Forms

Patient Forms for your convenience

We have included our patient forms for you to read and fill out. You can bring in your forms at your first visit, or utilize our online format to submit your patient forms to us digitally. At Dentistry For Health, we value your time and want your visit with Dr. Robin Khan to go well. Contact us for any questions or to make your appointment with our caring staff in Omaha, Nebraska.

  1. Patient Registration
  2. HIPAA Consent
  3. Financial and Appointment Agrements Form
  4. Reservation and Cancellation Policy
  5. Fatigue Severity Scale
  6. Acid Reflux Assessment Form
  7. Disclosure Policy
  8. Lanugage Assistance Form
  9. Pediatric Airway Evaluation
Address
10365 Pacific Street, Omaha, NE 68114
Contact
Phone 402-932-0282
Fax 402-932-0373
Email info@dentistryforhealthomaha.com
Office Hours
Monday 8:00am - 5:00pm
Tuesday 8:00am - 5:00pm
Wednesday 8:00am - 5:00pm
Thursday 8:00am - 2:00pm
Friday Closed