Please print out the forms below and fill out to bring in to your first appointment. Thank you and we are looking forward to seeing you soon.
Advanced Smiles Financial Policy
HIPPA Form 1-Privacy Practices
HIPPA Form 2-Receipt of Notice of Privacy Practices
HIPPA Form 3-Consent for Use and Disclosure
Please download Adobe Acrobat below to view/print forms:
Advanced SmilesDr. Tina Moheb685 Bloomfield Ave., Ste.
102Verona, NJ 07044 ph. 973.857.7799