Patient Forms

The following forms are provided to our patients. Please complete the forms before your appointment.

Financial Policy

HIPAA Form

Medical History

New Patient Form

If you have questions about any of the paperwork, please give us a call at one of our two locations, and our staff will be happy to help you.

Fay Periodontics, 207 East 63rd Street, Kansas City, MO 64113 ^ (816) 673-2230 ^ annfayperiodontics.com ^ 5/10/2023 ^ Page Phrases: Periodontist Kansas City MO ^

Patient Forms

Shawnee Location

Brookside Location