River Square Family Dentistry Logo

 New Patient Forms

Home
Our Philosophy
Preventative Care
Corrective Care
Technology
Dr. Girgis
Our Staff
What Our Patients Say
Special Offer
Contact Us
Map and Direction
New Patient Forms
Patient Education

 

Please click on the appropriate form below.
The New Patient Registration form is available .

All new patients are asked to  print and complete this form in advance of their appointment with our doctor. (Please remember to bring this form and all your insurance cards with you at the time of your appointment.)

If you have a problem seeing any of the following forms in your browser, you can right click on the form's link and choose 'Save target as' to save the form to your hard drive and then open it from there

  1. Patient Registration Form

  2. All Patients With Insurance Coverage Form

  3. PRIVACY NOTICE FOR PATIENTS
    Or you can download all the above documents if you click here.

Related Document:

  1. Questionnaire for current patients
     

Download this software to view forms on this page

The Office Forms you want can be viewed using Adobe? Acrobat Reader. To download this program, click here.
If you have a slower internet connection you can download Acrobat Reader version 4.05 (which is sufficient to read the forms of this site)

You may print these forms, complete the information and

  1. Bring it in at your schedule new patient appointment time, or
  2. Mail the form to our address.

 

 

 

 


 

 


 

Gehan Girgis D.D.S.
 930 W. Avon Suite #19 Rochester Hills, MI 48307
Phone: (248) 650-2440 Fax: (248) 650-8922
• Home • Our Philosophy • Preventative Care • Corrective Care • Technology • Dr. Girgis • Our Staff • What Our Patients Say • Special Offer • Contact Us • Map and Direction • New Patient Forms • Patient Education •