New Patient Forms

Please fill out and submit your secure HIPAA compliant online forms before your visit. Thank you.

By agreeing to the terms of our secure forms, you will enter a secure area of our website. TLC Dental of Rockland will not be held responsible in the event your electronic message is not transmitted due to technical problems related to this site or to the hosting server. All personal identifying information is encrypted and your message will not be internally or externally forwarded to other third parties. The information will solely be used by TLC Dental of Rockland. Your request will be processed within 24 hours, during normal business hours. If you do not accept the terms of this disclaimer, you will not be able to process your request online. If you have any questions regarding the use of these forms, please contact our office during normal business hours.

Patient Registration

HIPAA Form

Medical History Form

Dental History Form

COVID-19 Consent Form


Treatment Consent Forms

Zoom Whitening Consent Form

Invisalign Consent Form

Consent for Implant Placement

General Consent for Dental Treatments

Consent for Extraction