Brecksville Kids Dentistry | Patient Info
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Patient Forms

Save time and get a head start on your child’s dental visit!

Below you will find our required forms and agreements – all included in one easy file. Please print the PDF document, complete the forms, and bring all of the paperwork with you to your appointment.

Welcome Letter

New Patient Form

  • Patient Information
  • Health History Form
  • Office Policies
  • HIPAA Notice
  • Payment Agreement

We now offer an in house insurance membership plan for our families that do not have coverage by insurance.  It is called Brecksville Kids Membership. For a monthly fee, parents can enjoy knowing that their children will receive cleanings, x-rays, exams, fluoride, emergency exams and a significant discount on any dental treatment needed. Inquire at your child’s next appointment!