Patient Forms

Patient Forms

To print your dental patient forms only, click the links below:

For Sleep Apnea patients only, please download the forms below, fill them out, and email them back to Dr. Cross at crossdentistry@verizon.net :

Notice of Privacy Practices

Notice of Privacy Practices

Download

Informed Patient Consent

Informed Patient Consent

Download

Medical Records Release Form

Medical Records Release Form

Download

Epworth Sleepiness Scale

Epworth Sleepiness Scale

Download

Comprehensive Health History Questionnaire

Comprehensive Health History Questionnaire

Download

CPAP Intolerance Affidavit

CPAP Intolerance Affidavit

Download

It is crucial that we have a complete medical history including current medications & reasons for use

Call us at (301) 662-0300

or make an appointment

Contact Us

Hours of Operation

Monday-Thursday: 8:00 AM – 4:30 PM

Friday-Sunday: Closed