New Patient Forms

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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.

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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