Forms
"Happiness. Joy. It’s a pleasure to express these feelings with my new smile from Dr. Blum. His wonderful ability to adapt technology to my needs made all the difference in the world."

- J.J. -

For first time patients: Please print and fill out before your first appointment.
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Please pardon the inconvenience.)
 
Health Information Privacy Forms

Please use the forms below for the consent of limited use of health information and acknowledgement of receipt of our privacy practices.

Consent for Use and Disclosure
Acknowledgement of Privacy Practices
 
Information Forms

Please use the forms below to provide personal and medical information.



Patient Information Form
Medical Questionnaire

Privacy/Terms Of Use
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