Imperial Family Dental Center

New Patient Forms

Save time waiting in our office by filling out necessary forms online. Feel free to give us a call if you have any questions.

Patient Registration

Notice of Privacy Practice

Consent of Privacy Practice

Authorization to Release Records

Authorization to Transfer Records

HIPPA Release Form

Financial Policy

Medical History

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (308) 882-5123
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