Patient Forms - Simply Download, Fill Out, and Submit! - Click to Return to Main Menu
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Contactless Patient Forms

In our effort to help reduce the risk of transmission of germs that could cause the spread of infectious disease such as COVID-19 —now you can submit our Patient Forms online!

Our hope is to provide our patients with more “contactless yet safe & secure solutions” to retrieving some of our Patient Forms.

COVID-19 Online Patient Forms & Files

The latest online patient forms adhearing to our new COVID-19 safety protocol.

COVID-19 Protocol COVID-19 Protocol
Please observe our new office policies to help mitigate risks of infection within our dental office.

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Screening Form Screening Form
This form helps us gauge any potential signs of symptoms prior to being seen by one of our dentists.

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COVID-19 Protocol Patient HIPAA Questionnaire
HIPAA is concerned with protecting the means in which your personal, private info is collected, stored, or transmitted to our office.

Online Patient Forms Directory

Here you can find and fill out our patient forms prior to your scheduled appointment.

Adult Patient Form Adult - Patient Form
For new Adult patients, including returning patients who may need to update their patient information.

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Adult Patient Form Minor - Patient Form
This patient form is meant to be completed by the legal guardian and or parent of a minor.

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Ask Dr. Mora Ask Dr. Mora
Appointment Request

Mora Dentistry is currently limiting our appointments to emergency visits. Feel free to contact us for more information.

Patient Forms

Patient Forms Directory

Here you can download our patient forms and review the information prior to your first appointment. You may fill out the form at home or in our office.

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Adult Patient FormAdobe PDF Reader:
Can't open a file? You may need to install the latest Adobe Acrobat Reader DC onto your computer.
Download it here. For mobile devices, install the free Adobe Reader App to work with PDF documents from your mobile device. Adobe Reader is the free and trusted leader for reliably viewing and interacting with PDF documents across platforms and devices.

Adult Patient Form Adult - Patient Form: This patient form is specifically for our Adult patients. divider Minor Patient Form Minor - Patient Form: This patient form is meant to be completed by the legal guardian and ⁄ or parent of a minor.


HIPAA Policy
This form acknowledges you have been well informed of your privacy rights with respect to the personal health information you provided us.

Care after Fillings Care After Fillings: Download this PDF file to reference helpful Care After Fillings tips.

dividerCare after Extraction Care After Extraction: Download this PDF file to reference helpful Care After Extraction tips.

Financial Policy
We feel that everyone benefits when there is a definite and clear understanding of our financial policy prior to treatment.

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