Patient Forms

At Family Smile Center LLC, we understand that your time is valuable. To save you some time during your first visit with Dr. Dinh and Dr. Cha, we have provided our new patient forms here. Simply click on the links below to download our forms and complete them before your first appointment with our dentists in Frederick, Maryland. We have also provided some of our other office forms to provide you with the information you need and help you feel prepared for your visits to our practice. If you need assistance, please do not hesitate to contact our friendly team today. We are glad to assist you!

Online Form

Online Patient Form

CONSENT Forms

Consent for Surgery
Consent for Implants
Consent for Root Canal
N2O Consent and Disclaimer

New Patient Forms

About Financial Arrangement
New Patient Form
Pediatric New Patient Form
Notice of Privacy Practices

Ortho Appliance Forms

Bionator
Halb Holding Arch Lip Bumper
Sagital Appliance
Schwarz Plate

Other Office Documents

About Warranties
FSC Brochure
Get Things Straight

Post Op Instructions

Gum Graft
Instructions Following Oral Surgery
Instructions Following Scrp Lavender
Post OP Final Crown
Post OP Root Canal
Post OP Temporary Inlay
Temporary Crown post OP

Waiver Forms

Waiver for Cleaning and Exam
Waiver for Cleaning and X-Ray
Waiver for Premedication