Patient Forms

The Fleischer Dental Group provides our patients with office forms on this website for your convenience. We recommend you print and fill these forms out at home to save time while in our office.

Please select .PDF file to download for Patient Instructions

	Patient Registration - page 1
	Medical History - page 1
	X-Ray Records Release - page 1
	HIPPA Compliance - page 1
	Financial Agreement - page 1

If you do not have a copy of Acrobat Reader you can get one for free by clicking here. This will take you to Adobe's website and enable you to download the Acrobat program to your computer.

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Dentists Dr. Michael Fleischer, Dr. Jill Fleischer, Dr. Stephen Scotto, and Dr. Mary McAllister Davis, serving Bellmore, Merrick, Wantagh, Massapequa Park,
Seaford, East Meadow, Levittown, Baldwin, Freeport, Hicksville, and all surrounding areas.

Fleischer Dental Group | 2085 Bellmore Ave | Bellmore, NY 11710 | Tel: 516-826-3520 | www.fleischerdentalgroup.com

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