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Patient Forms

Finding an affordable dental office can often be a challenge. Fortunately, the Hocking College Dental Hygiene Clinic can satisfy all your basic dental hygiene needs. The following forms are for you to download and print so that paperwork can be completed prior to your appointment. If  you cannot download and print from home or work, don't worry, we can give you the forms at your first appointment.

1. Download & Print: New Patient Forms 

Please download, print, fill out, and bring the following documents to your first appointment. 

American Dental Association (ADA) Medical History

The ADA medical history form helps us to better treat you. The more information that we have about your dental history, the better care we can provide. Don't worry about being judged or embarrassed if  you haven't had dental care in a while. You can feel comfortable discussing all the important details of your oral health habits and history. Our only concern is improving your oral health. Therefore, it's crucial that your complete, accurate medical and dental history is disclosed on your first visit.

ADA Medical History - Adult ADA Medical History - Child


Patient Document Signature Sheet

The Patient Document Signature Sheet acknowledges the receipt of our policies (listed under #3).

Patient Document Signature Sheet

2. Download & Print: Consent Forms

Local Anesthetic Consent Form

New Patient Consent Form

3. Download & Print: Policies

Please print and read the following policies for your personal records:

Patient Bill of Rights

Hocking College Privacy Policy

Patient Standard of Care