Thank you for choosing the practice of Dr. Jerry Rinehart for your dental needs.
For your convenience we have created interactive PDF forms for our New Adult Patients, New Child Patients and HIPAA Policies.
Please click on the form images below and download the appropriate forms to your computer, tablet or smart phone. From there you will be able to fill in all of the appropriate responses in the convenience of you own home before your initial appointment time. Once you have completed the form(s), please save for your records and either print to your printer and bring with you to the initial meeting or attach the saved, completed form(s) to an email and send to: firstname.lastname@example.org
If you have difficulty downloading the PDF Forms, please call us at
We thank you for taking the time to fill out the form(s) and we look forward to meeting with you and becoming your dentist.