For your convenience, our secure forms are available online.  Scroll down to see the entire list.

*** If you access our website or forms from a work computer, please be aware that your employer’s security settings may block access. If that happens, we recommend using a personal device or connecting through a home network instead. ***

Update Credit Card on File

Change or update your payment plan Visa, Mastercard, or Discover.  Does NOT make a one-time payment.

Pay with Credit Card

Make a one-time payment with Visa, Mastercard, or Discover.  Does NOT change or update the payment plan credit card on file.

Insurance

Online form to provide your insurance details.

Reports

Request financial & appointment reports, school & work excuses, & more.

Records Release

Authorize the release of records TO Dr. Tsintolas.

Patient Updates

Update names, addresses, phone numbers, email, general dentist, etc. for patients, parents/guardians.

Child/Teen Registration
Less than 18 years of age.

Do NOT submit unless specifically directed to do so by our office.

Adult Registration
18+ years of age

Do NOT submit unless specifically directed to do so by our office.

Share

For use upon direction by our office.

NOTICE OF PRIVACY PRACTICES

For your reference.

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