Patient Forms

At Steckelberg Dental, we recognize the value of your time. We are pleased to offer you the option of completing most of your new patient paperwork online prior to arriving at our office.

Once you have an appointment scheduled with us, please visit the new patient area link below and submit your chart information electronically. If you do not want to utilize the digital patient forms, please let us know, and we will have forms ready for you to complete by hand in our office.

Occasionally, we will ask our current patients to visit this webpage and update their records, including medical history. Our staff updates medical history in office at each checkup appointment. However, if it has been more than a year since you’ve been seen at Steckelberg Dental, we may ask you to complete a new medical history.

We are proud to post our HIPAA compliance forms online for your review at your convenience. Documents below are signed electronically in our office – you won't need to print them, just review if desired.

HIPAA Notice of Privacy Practices

Our goal is to work within a reduced-paper environment. We obtain your signature and authorization electronically whenever possible. In addition, when available, we submit electronic claims to your insurance company instead of paper claims.

If you would like to request copies of your dental records, we do require a written release. In order for those records to be sent to a new dental office, or for your own use, just complete the form below and send it to our office. Our standard way of transmitting your records is via Secure Electronic Mail that is HIPAA compliant. Please read page 1 of our Records Request Release Form for further instructions.

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*These forms require Adobe Acrobat Reader. Click the Adobe logo to download.