Now accepting Telehealth appointments. Schedule a virtual visit.

Patient Forms


Please use the links below to download the forms you will need to fill out before visiting our office for the first time and to read about our cancellation policy. From the links below, all forms can be filled out on your computer, saved, and conveniently emailed to us at before your appointment. You can also print them out and hand carry them in at the time of your visit.

Dental History

Medical History

Patient Information

Appointment Policy

HIPAA Acknowledgement

Patient Advisory and Acknowledgement for COVID-19

Authorization and Consent

Filling out the forms on your computer:

  • Click the links above to open the forms in your browser
  • Select the fields and type in your information
  • Save the form by downloading it to your computer
  • Email the forms to our office at


Please note: We take your privacy very seriously. The website and email of James E. Jacobs, DMD & Tara A. Bogart, DDS is fully HIPAA compliant. Transmitting patient information relating to treatment, health, or payment by email is encrypted if both parties have HIPAA compliant emails.  However, forms sent from email addresses that are not HIPAA compliant (most personal email addresses) have a risk of compromising your private information. If you feel more comfortable, please print out the forms and bring them to our office at the time of your appointment.