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Patient Intake Forms

Please email a copy or photo of insurance card and/or driver's license to the (encrypted e-mail) or you will need to bring your driver's license and insurance cards with you for scanning at your first appointment.  If you have any questions, please call Jenn Renn at (208) 282-3282.

Patient Records Request

All patients will have the ability to review, inspect and/or obtain a copy of the PHI in the Dental Health Record.

Patients may request to review and inspect their Dental Records at any time. A patient does not have the right to immediate access to his or her medical/dental record under the HIPAA Privacy Rule.

Patients may request a paper copy and/or electronic file, of their Dental Record by completing and signing an Authorization to Release Protected Health Information (PHI) Form. All patient requests will be completed within 10 business days.