Forms

Patient Information

Complete Our Online Patient Forms

Please complete our online forms below before your appointment. You can also download & print the forms by following the link below.

If you're not able to complete our forms online, please arrive at least 15-minutes early to allow time to complete the medical/dental health questionnaire and the patient information form. If you have a complicated health history, please mail it to our office so that we might review it in advance. Be sure to list all medications with dosages and any natural supplements, attaching an extra sheet if necessary.


Referring Doctors Online Forms

At Acharya Periodontics & Implants, we value our relationships with referring dental practices and are proud to partner with you in providing excellent oral healthcare to our community.

Doctors may refer patients to our office by filling out our secure online Referral Form below. After you have completed the form, please make sure to click X button at the bottom to automatically send us your information. The security and privacy of patient data are one of our primary concerns and we have taken every precaution to protect it.

  • Review cases thoroughly in advance
  • Refer back to your office for restorations
  • Collaborate with you on treatment plans
  • Are available in an advisory role
  • Offer accommodating scheduling
  • Provide timely assessments and imaging

HIPAA & Privacy Policy

We believe that our medical and other health information is private and should be protected, and we want to know who has this information. The Privacy Rule, a Federal law, gives you rights over your health information and sets rules and limits on who can look at and receive your health information. Learn more about your protected health information.

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