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Patient Forms


Reception desk at Tiny Teeth Pediatric Dentistry, that helps you with patient forms.To accelerate check-in and decrease your time in our waiting room, we make patient forms available online for you to complete prior to your appointment.

***Be sure to bring your insurance card the day of your appointment.***


New Patient Packet


Click here to complete the new patient forms online.

Release of Records


Click here to complete the release of records document.

IV Sedation Pre-Operative Agreement


Click here to complete the pre-op sedation agreement.

Adobe Document Cloud e-sign services comply with industry security standards, including HIPAA and PCI v3.0 used by the payment card industry. In addition, due to multiple protections and certifications, e-signatures are typically more secure than pen and ink signatures. For more information about Adobe Document Cloud Security, View this document.

Office hours

Mon–Thurs 8:00 a.m.–5:00 p.m.
Fri 7:00 a.m.–2:00 p.m.

Location

3933 N Maize Road
Wichita, KS 67101-9619

¡Hola!

Habla Español

Contact

Office (316) 202-9629
Fax (316) 202-0141

Copyright © 2017-2021 Tiny Teeth Pediatric Dentistry and WEO Media (Touchpoint Communications LLC). All rights reserved.  Sitemap | Links | Privacy Policy
Patient Forms Wichita KS • Tiny Teeth Pediatric Dentistry
To accelerate check-in and decrease your time in our waiting room, we make patient forms available online for you to complete prior to your appointment.
Tiny Teeth Pediatric Dentistry, 3933 N. Maize Road, Suite 200 Wichita, KS 67101; (316) 202-9629; tinyteethwichita.com; 6/13/2021; Page Terms:Pediatric Dentist Wichita KS; Pediatric Dentist Wichita KS;