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Patient Forms


a doctor speaking with a patient and using a laptopThe 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 (816) 673-2230 and our staff will be happy to help you.
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Fay Periodontics, 207 East 63rd Street, Kansas City, MO 64113 \ (816) 673-2230 \ brookside.annfayperiodontics.com \ 4/13/2021 \ Key Phrases: dental implants Kansas City MO \ dental implants Kansas City MO \