Call us: (520) 297-9069
Arizona Dental Medicine
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  • Contact Us
  • Home
  • Our Office
    • Office Info
    • Doctors
    • Our Team
    • Hours & Directions
  • Services & Patient Education
    • Services & Patient Education
    • Patient Forms
    • Patient Reviews
    • Appointment
    • Insurance/Payment
  • Contact Us

Patient Forms

We are dedicated to assisting you in a timely manner!

Please print the forms and bring with you at the time of your first appointment. Thank you and we are looking forward to seeing you.

  • Patient Registration
  • General Consent
  • Financial Policy
  • Oral Cancer Screening
  • Medical History
  • HIPA Authorization for Release of Identofying Health Information
  • HIPA Medical Information Disclosure and Access Notice
  • HIPA Notice of Privacy Practices
  • TMD / Dental Sleep Medicine
  • Records Release – Going Out
  • Records Release – Coming In
  • Military: Form 2813 Available in office

Featured Services

  • Orthodontics
  • Cosmetic Dentistry & Facial Aesthetics
  • Partials, Dentures, Crowns and Bridges
  • Oral Surgery / Dental Implants
  • Root Canals
  • Teeth Whitening
  • TMJ Treatment
  • Preventative Dental Care

Recent Posts

  • Dental Health & Your Diet May 28, 2015
  • Electric versus Manual Brush May 26, 2015
  • Bad Breath May 26, 2015
  • Invisible Braces Bring Visible Results December 20, 2012
  • Painful Mouth Sores – Canker versus Cold November 29, 2012

Post Categories

Featured Products

Tucson Orthodontics
Tucson Dentist lumineers veneers
six month smiles

Links:

  • American Academy of Craniofacial Pain
  • American Academy of Pain Management
  • American Academy of Sleep Medicine
  • American Board of Craniofacial Pain
  • International College of Cranio-Mandibular Orthopedics

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Find Us

Arizona Dental Medicine

6596 N. Oracle Rd. Tucson AZ 85704

(520) 297-9069

services@azdentalmed.com

Testimonials

I am a long standing patient of Arizona Dental Medicine and highly recommend the practice for their trust, caring and service. My care has… See All

Darin Goss

The experiences I’ve had thus far have been great! I’ve had problems with anxiety in the past but not with this dentist. See All

Patient Review – Landi W.

As I was eating my lunch one day I was dismayed to discover that I had broken a tooth. I called Dr. Riley at… See All

James Kimes

I am SOOO happy I found Dr. Rochelle Riley three years ago. From the moment I met her, I knew I found my dentist… See All

Susan Garcia

“I recently had the last of my amalgam fillings removed and a chip on my front tooth taken care of by Dr. Riley. I… See All

Nadine Butler

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