Welcome, and thank you for choosing Sunrise Pediatric Dentistry. The information provided on this form is important to your child's dental health and should be completed by a parent or legal guardian. Please submit a separate form for each of your children. We look forward to caring for your family.
Please note: If you plan on using dental insurance for your child's visit, you must include that information below. If we do not have that information 24 hours prior to your appointment, please plan to arrive 30 minutes prior to your appointment time with your insurance card. This will ensure that we have ample time to review your benefits at the time of your child's visit and answer any questions you may have. We appreciate your help!
Please complete this form for new patients ages 0-17.