Patient Forms
Dental care is an important component to your child’s health. Sign up today for our dental program!
https://drbenham.com/forms/Healthy%20Kids%20School%20Form.pdf
The notice linked below describes how medical information about you may be used and disclosed and how you can get access to this information in accordance with HIPPA regulations. Please review it carefully.
https://drbenham.com/forms/HIPAA%20Notice%20of%20Privacy%20Practices.pdf
Please fill the below form out to acknowledge your understanding of our privacy practices in accordance with HIPPA regulations.
This form is for new adult patients.
This form is for new child patients.