Patient Forms

At the time of your first visit, you will be asked to fill out and sign some forms to provide us some information about you. For your convenience, you may download these forms here and prepare them in advance. Feel free to fax or bring in the completed forms.

Patient Information Form — This form provides us with your basic information, including name and contact information, insurance information, and brief medical history.

Anesthesia Consent — This form provides an explanation of our anesthesia policy as well as supplying us with your permission to use anesthesia as appropriate.

Our Privacy Practices — This form defines the patient privacy practices that we follow.

Health Information Consent — This form provides us with permission to use and disclose your health information to carry out treatments, payment activities, and healthcare processes. Please read “Our Privacy Practices” first, then fill in and sign this form.

These forms are pdf documents that require Adobe Reader software. If you’re unable to open PDF files, you can get Adobe Reader®for free.

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YEARS OF EXPERIENCE
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HAPPY PATIENTS
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IMPLANTS PLACED LAST YEAR
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POSITIVE REVIEWS

Visiting Esthetique Dentistry was probably the best experience I have had with a dental practice ever. You can tell that they pay attention to detail and take time to ensure a holistic view of your dental health is considered. I would recommend the practice to anyone.

Jordan, Google ⭐⭐⭐⭐⭐

After moving to the area I needed to find a dentist to do some extensive work – my wife and I found Esthetique Dentistry and we could not be happier. The staff is polite professional and understanding. Everything is clearly explained, questions are invited and answered, and most importantly patient comfort is a priority.

Ian, Yelp ⭐⭐⭐⭐⭐

I have a dentist phobia but everyone at Esthetique made me feel so welcome and at home. From the awesome staff at the front desk, Diana in customer service, the dental assistants and hygienists and finally to Dr. Talwar – my experience could not have been better. The office is clean, state of the art.

Patricia, Google ⭐⭐⭐⭐⭐

(703) 729-6222
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