Phone: (317) 460-6884

Patient Forms

All The Forms

We have made all of our patient forms available to you in one location as Adobe Acrobat files.

FOR OFFICE USE ONLY--Oral Surgery Checklist
Pre-operative Instructions for Dental Anesthesia Surgery  Medical History Update Form  Medical Consultation for Dental Surgery  Patient Treatment Record  Moderate Sedation Record  Disclosure & Consent for Dental Surgery  Nerve Injury Disclosure & Consent   Post-operative Instructions Following Dental Anesthesia/Surgery  Rx Sheet   Acknowledgment:  Receipt of Notice of Privacy Practices  COVID-19 Questionnaire 

Miscellaneous Forms

 Anesthesia Consent Form  Bisphosphonates Consent Form  Coronectomy Consent Form

Contact Dr. Fortner

(317) 460-6884