Patient Forms

If you are a new patient to our office, the forms below will need to filled out when you arrive for your first appointment in our dental office. Printing them, filling them out and bringing them with you will allow us to attend to your dental needs more quickly than completing them on your arrival.  Thank you and please call our dental office if you have any questions or need any assistance. 

New Patient Registration Form (Pt Health Hx.pdf)


HIPAA Privacy Act (shown upon arrival)

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

 

Hodge and Lancaster Family Dental
Jeffrey L. Hodge, DDS & Matthew C. Lancaster, DDS
Giving Our Neighbors A Smile

Hodge Family Dental provides dentistry to Lafayette Indiana and specializes in family dentistry. Call our office to learn more!

2024

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321 N 22nd StreetLafayette, IN 47904Get Directions765-447-6733

2024

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