New Patient Forms

Child with paint on their hands and face

Sunshine Pediatric Dentistry of Evansville

New Patient Forms

Prior to your child’s appointment, we ask that
you download and print the New Patient Packet (PDF) to complete all required forms.

New Patient Packet includes
the following individual forms.


General Patient Information
HIPAA – Notice of Privacy
Financial Guidelines
Financial Responsibility Agreement

Referring Physicians? Please use the form below.

Referring Physician Medical Clearance Form

 
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Contact Us

(812) 477-2836

Sunshine Pediatric
Dentistry of Evansville

701 N Weinbach Ave, Suite 910
Evansville, IN 47711-6607
Click for map & directions

Hours

Mon
Tue
Wed
Thu
Fri
Sat
Sun

8:00 am – 5:00 pm
8:00 am – 5:00 pm
8:00 am – 5:00 pm
8:00 am – 5:00 pm
By Appointment Only
Closed
Closed