Patient Forms
Patient Intake Form
Complete your secure patient intake before your first visit so our team can prepare your chart.
Patient Forms
Before Your Visit
Submitting your intake information in advance helps our administrative and nursing team review your medical history, medications, and appointment details before you arrive.
- Use the secure online form
- Include current medications
- Provide accurate contact information
- Call us if you are unsure what to enter
Patient Forms
Privacy And Security
The security and privacy of your personal data is one of our primary concerns. Please complete the form carefully and submit it through the secure portal.
Need Help?
Questions About This Form?
Call our Waterloo office if you are unsure which form applies or how to prepare before your appointment.
Forms FAQ
Questions About Patient Intake Form
When should I complete the patient intake form?
Complete the patient intake form before your first visit whenever possible so the Waterloo office can review medical history, medications, contact information, and appointment details.
What information is needed for patient intake?
Patients should provide accurate contact details, health history, medication lists, allergies, dental concerns, and any information requested by the secure form.
What if I am unsure how to answer a question?
Call the office before submitting if you are unsure. The team can help clarify what information is needed.
Ready to connect?
Call Our Waterloo Oral Surgery Office.
Directions
Online Map & Driving Directions
Visit our Waterloo oral and maxillofacial surgery office at 96 Union Street East. Open our Google Business Profile for directions, office details, and patient reviews before your appointment.
Find directions, parking context, business profile details, and Google reviews for our Waterloo office.