Phone: (317) 460-6884

Patient Forms

We have made all of our patient forms available to you in one location as Adobe Acrobat files.  For your safety and convenience, we recommend printing and completing these forms in the comfort of your home.

Please remember to bring your completed forms with you for your first appointment.  If you have any problem getting these files to print properly, please call our office, and we will gladly send or fax them to you.

Pre-operative Instructions for Dental Anesthesia Surgery  Medical History Update Form  Medical Consultation for Dental Surgery  Disclosure & Consent for Dental Surgery  Nerve Damage Disclosure & Consent   Post-operative Instructions Following Dental Anesthesia/Surgery   Acknowledgment:  Receipt of Notice of Privacy Practices  COVID-19 Questionnaire 

In addition, the following miscellaneous forms may also be required.  Please check with your dentist or with Dr. Fortner to confirm:

Anesthesia Consent Form  Bisphosphonates Consent Form  Coronectomy Consent Form

Contact Dr. Fortner

(317) 460-6884