{"id":251,"date":"2026-07-23T10:53:39","date_gmt":"2026-07-23T14:53:39","guid":{"rendered":"https:\/\/holmesandputney.com\/?page_id=251"},"modified":"2026-08-24T09:17:04","modified_gmt":"2026-08-24T13:17:04","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/holmesandputney.com\/?page_id=251","title":{"rendered":"Patient Forms"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"251\" class=\"elementor elementor-251\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c62796c e-flex e-con-boxed e-con e-parent\" data-id=\"c62796c\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-65423d6 elementor-widget elementor-widget-heading\" data-id=\"65423d6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Patient Forms<\/h1>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-ed73ff1 e-flex e-con-boxed e-con e-parent\" data-id=\"ed73ff1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7644a20 elementor-widget elementor-widget-heading\" data-id=\"7644a20\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Print and Complete Before Your Visit<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fd1252f elementor-widget elementor-widget-text-editor\" data-id=\"fd1252f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p class=\"font-claude-response-body break-words whitespace-normal\" dir=\"ltr\">Thank you for choosing our practice for your dental care. On this page, you&#8217;ll find the forms needed for your upcoming visit. Simply click the link for the form you need, print it out, fill it in and bring to your visit.\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d2e41da elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"d2e41da\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/holmesandputney.com\/wp-content\/uploads\/2026\/08\/Dental_hist_1.pdf\" target=\"_blank\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-file-alt\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M288 248v28c0 6.6-5.4 12-12 12H108c-6.6 0-12-5.4-12-12v-28c0-6.6 5.4-12 12-12h168c6.6 0 12 5.4 12 12zm-12 72H108c-6.6 0-12 5.4-12 12v28c0 6.6 5.4 12 12 12h168c6.6 0 12-5.4 12-12v-28c0-6.6-5.4-12-12-12zm108-188.1V464c0 26.5-21.5 48-48 48H48c-26.5 0-48-21.5-48-48V48C0 21.5 21.5 0 48 0h204.1C264.8 0 277 5.1 286 14.1L369.9 98c9 8.9 14.1 21.2 14.1 33.9zm-128-80V128h76.1L256 51.9zM336 464V176H232c-13.3 0-24-10.7-24-24V48H48v416h288z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">New Patient Registration Form (Adult)<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/holmesandputney.com\/wp-content\/uploads\/2026\/08\/NPprofile_1.pdf\" target=\"_blank\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-file-alt\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M288 248v28c0 6.6-5.4 12-12 12H108c-6.6 0-12-5.4-12-12v-28c0-6.6 5.4-12 12-12h168c6.6 0 12 5.4 12 12zm-12 72H108c-6.6 0-12 5.4-12 12v28c0 6.6 5.4 12 12 12h168c6.6 0 12-5.4 12-12v-28c0-6.6-5.4-12-12-12zm108-188.1V464c0 26.5-21.5 48-48 48H48c-26.5 0-48-21.5-48-48V48C0 21.5 21.5 0 48 0h204.1C264.8 0 277 5.1 286 14.1L369.9 98c9 8.9 14.1 21.2 14.1 33.9zm-128-80V128h76.1L256 51.9zM336 464V176H232c-13.3 0-24-10.7-24-24V48H48v416h288z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">New Patient Registration (Child)<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/holmesandputney.com\/wp-content\/uploads\/2026\/08\/medicalhistAD_1.pdf\" target=\"_blank\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-file-alt\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M288 248v28c0 6.6-5.4 12-12 12H108c-6.6 0-12-5.4-12-12v-28c0-6.6 5.4-12 12-12h168c6.6 0 12 5.4 12 12zm-12 72H108c-6.6 0-12 5.4-12 12v28c0 6.6 5.4 12 12 12h168c6.6 0 12-5.4 12-12v-28c0-6.6-5.4-12-12-12zm108-188.1V464c0 26.5-21.5 48-48 48H48c-26.5 0-48-21.5-48-48V48C0 21.5 21.5 0 48 0h204.1C264.8 0 277 5.1 286 14.1L369.9 98c9 8.9 14.1 21.2 14.1 33.9zm-128-80V128h76.1L256 51.9zM336 464V176H232c-13.3 0-24-10.7-24-24V48H48v416h288z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Medical History Form (Adult)<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/holmesandputney.com\/wp-content\/uploads\/2026\/08\/medicalhistCH_1.pdf\" target=\"_blank\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-file-alt\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M288 248v28c0 6.6-5.4 12-12 12H108c-6.6 0-12-5.4-12-12v-28c0-6.6 5.4-12 12-12h168c6.6 0 12 5.4 12 12zm-12 72H108c-6.6 0-12 5.4-12 12v28c0 6.6 5.4 12 12 12h168c6.6 0 12-5.4 12-12v-28c0-6.6-5.4-12-12-12zm108-188.1V464c0 26.5-21.5 48-48 48H48c-26.5 0-48-21.5-48-48V48C0 21.5 21.5 0 48 0h204.1C264.8 0 277 5.1 286 14.1L369.9 98c9 8.9 14.1 21.2 14.1 33.9zm-128-80V128h76.1L256 51.9zM336 464V176H232c-13.3 0-24-10.7-24-24V48H48v416h288z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Medical History Form (Child)<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/holmesandputney.com\/wp-content\/uploads\/2026\/08\/HIPPAABfam_1.pdf\" target=\"_blank\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-file-alt\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M288 248v28c0 6.6-5.4 12-12 12H108c-6.6 0-12-5.4-12-12v-28c0-6.6 5.4-12 12-12h168c6.6 0 12 5.4 12 12zm-12 72H108c-6.6 0-12 5.4-12 12v28c0 6.6 5.4 12 12 12h168c6.6 0 12-5.4 12-12v-28c0-6.6-5.4-12-12-12zm108-188.1V464c0 26.5-21.5 48-48 48H48c-26.5 0-48-21.5-48-48V48C0 21.5 21.5 0 48 0h204.1C264.8 0 277 5.1 286 14.1L369.9 98c9 8.9 14.1 21.2 14.1 33.9zm-128-80V128h76.1L256 51.9zM336 464V176H232c-13.3 0-24-10.7-24-24V48H48v416h288z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">HIPAA Authorization Form<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/holmesandputney.com\/wp-content\/uploads\/2026\/08\/paymtpol_1.pdf\" target=\"_blank\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-file-alt\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M288 248v28c0 6.6-5.4 12-12 12H108c-6.6 0-12-5.4-12-12v-28c0-6.6 5.4-12 12-12h168c6.6 0 12 5.4 12 12zm-12 72H108c-6.6 0-12 5.4-12 12v28c0 6.6 5.4 12 12 12h168c6.6 0 12-5.4 12-12v-28c0-6.6-5.4-12-12-12zm108-188.1V464c0 26.5-21.5 48-48 48H48c-26.5 0-48-21.5-48-48V48C0 21.5 21.5 0 48 0h204.1C264.8 0 277 5.1 286 14.1L369.9 98c9 8.9 14.1 21.2 14.1 33.9zm-128-80V128h76.1L256 51.9zM336 464V176H232c-13.3 0-24-10.7-24-24V48H48v416h288z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Financial Policy<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/holmesandputney.com\/wp-content\/uploads\/2026\/08\/prvtpol_1.pdf\" target=\"_blank\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-file-alt\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M288 248v28c0 6.6-5.4 12-12 12H108c-6.6 0-12-5.4-12-12v-28c0-6.6 5.4-12 12-12h168c6.6 0 12 5.4 12 12zm-12 72H108c-6.6 0-12 5.4-12 12v28c0 6.6 5.4 12 12 12h168c6.6 0 12-5.4 12-12v-28c0-6.6-5.4-12-12-12zm108-188.1V464c0 26.5-21.5 48-48 48H48c-26.5 0-48-21.5-48-48V48C0 21.5 21.5 0 48 0h204.1C264.8 0 277 5.1 286 14.1L369.9 98c9 8.9 14.1 21.2 14.1 33.9zm-128-80V128h76.1L256 51.9zM336 464V176H232c-13.3 0-24-10.7-24-24V48H48v416h288z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Notice of Privacy Practices<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-44df970 elementor-widget elementor-widget-text-editor\" data-id=\"44df970\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p class=\"font-claude-response-body break-words whitespace-normal\" dir=\"ltr\">If you have any questions while filling out your forms, please call our office at <a href=\"tel:2522378812\">(252) 237-8812.<\/a> We&#8217;re happy to help!<\/p><p class=\"font-claude-response-body break-words whitespace-normal\" dir=\"ltr\">\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Patient Forms Print and Complete Before Your Visit Thank you for choosing our practice for your dental care. On this page, you&#8217;ll find the forms needed for your upcoming visit. Simply click the link for the form you need, print it out, fill it in and bring to your visit.\u00a0 New Patient Registration Form (Adult) [&hellip;]<\/p>\n","protected":false},"author":229270516,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"jetpack_seo_schema_type":"","_wpcom_ai_launchpad_about_page":false,"_wpcom_ai_launchpad_gallery_page":false,"_wpcom_ai_launchpad_contact_page":false,"_wpcom_ai_launchpad_events_page":false,"_wpcom_ai_launchpad_video_page":false,"_wpcom_ai_launchpad_portfolio_piece":false,"footnotes":""},"class_list":["post-251","page","type-page","status-publish","hentry"],"jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/PhjPZE-43","jetpack-related-posts":[{"id":161,"url":"https:\/\/holmesandputney.com\/","url_meta":{"origin":251,"position":0},"title":"Home","author":"David","date":"July 13, 2026","format":false,"excerpt":"Family-focused dental care you can trust. Providing families with compassionate, comprehensive dental care for more than 25 years. Schedule Appointment Why Choose Holmes & Putney? Patient-Focused Care We believe the best dental care starts with listening to our patients and creating a comfortable, open environment. Thorough, Personalized Care We take\u2026","rel":"","context":"Similar post","block_context":{"text":"Similar post","link":""},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/holmesandputney.com\/wp-content\/uploads\/2026\/08\/IMG_0110.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/holmesandputney.com\/wp-content\/uploads\/2026\/08\/IMG_0110.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/holmesandputney.com\/wp-content\/uploads\/2026\/08\/IMG_0110.jpg?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/holmesandputney.com\/wp-content\/uploads\/2026\/08\/IMG_0110.jpg?resize=700%2C400&ssl=1 2x, https:\/\/i0.wp.com\/holmesandputney.com\/wp-content\/uploads\/2026\/08\/IMG_0110.jpg?resize=1050%2C600&ssl=1 3x, https:\/\/i0.wp.com\/holmesandputney.com\/wp-content\/uploads\/2026\/08\/IMG_0110.jpg?resize=1400%2C800&ssl=1 4x"},"classes":[]},{"id":309,"url":"https:\/\/holmesandputney.com\/?page_id=309","url_meta":{"origin":251,"position":1},"title":"Directions","author":"Melanie Raynor","date":"August 4, 2026","format":false,"excerpt":"Directions Find Our Wilson Office Holmes & Putney is conveniently located at:2801 Wooten Blvd SW, Building BWilson, NC 27893Phone: (252) 237-8812We're proud to serve patients from Wilson and the surrounding communities. If you have any trouble finding us, please give our office a call and we'll be happy to guide\u2026","rel":"","context":"Similar post","block_context":{"text":"Similar post","link":""},"img":{"alt_text":"Holmes and Putney Office building","src":"https:\/\/i0.wp.com\/holmesandputney.com\/wp-content\/uploads\/2026\/07\/HolmesPutney-office-e1787061455205-1024x648.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/holmesandputney.com\/wp-content\/uploads\/2026\/07\/HolmesPutney-office-e1787061455205-1024x648.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/holmesandputney.com\/wp-content\/uploads\/2026\/07\/HolmesPutney-office-e1787061455205-1024x648.jpg?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/holmesandputney.com\/wp-content\/uploads\/2026\/07\/HolmesPutney-office-e1787061455205-1024x648.jpg?resize=700%2C400&ssl=1 2x"},"classes":[]},{"id":423,"url":"https:\/\/holmesandputney.com\/?page_id=423","url_meta":{"origin":251,"position":2},"title":"Privacy Policy","author":"Melanie Raynor","date":"August 5, 2026","format":false,"excerpt":"Privacy Policy Effective Date: August 5, 2026Holmes & Putney, D.D.S., P.A. (\"we,\" \"our,\" or \"us\") respects your privacy and is committed to protecting the personal information of visitors to our website. This Privacy Policy explains what information we collect through this website, how we use it, and the choices you\u2026","rel":"","context":"Similar post","block_context":{"text":"Similar post","link":""},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":412,"url":"https:\/\/holmesandputney.com\/?page_id=412","url_meta":{"origin":251,"position":3},"title":"Accessibility Statement","author":"Melanie Raynor","date":"August 5, 2026","format":false,"excerpt":"Accessibility Statement Effective Date: August 5, 2026Holmes & Putney, D.D.S., P.A. is committed to ensuring that our website is accessible to everyone, including individuals with disabilities. We strive to follow the Web Content Accessibility Guidelines (WCAG) 2.1, Level AA, and we regularly review our website to improve its usability for\u2026","rel":"","context":"Similar post","block_context":{"text":"Similar post","link":""},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]}],"_links":{"self":[{"href":"https:\/\/holmesandputney.com\/index.php?rest_route=\/wp\/v2\/pages\/251","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/holmesandputney.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/holmesandputney.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/holmesandputney.com\/index.php?rest_route=\/wp\/v2\/users\/229270516"}],"replies":[{"embeddable":true,"href":"https:\/\/holmesandputney.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=251"}],"version-history":[{"count":54,"href":"https:\/\/holmesandputney.com\/index.php?rest_route=\/wp\/v2\/pages\/251\/revisions"}],"predecessor-version":[{"id":624,"href":"https:\/\/holmesandputney.com\/index.php?rest_route=\/wp\/v2\/pages\/251\/revisions\/624"}],"wp:attachment":[{"href":"https:\/\/holmesandputney.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=251"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}