patient Forms

If you are a new patient, please complete Our New Patient Forms.


Please complete the forms above prior to your appointment and bring them along with you. If you are unable to print or complete the forms prior to your appointment, please arrive 15 minutes early to your scheduled appointment. Our First Visit Forms above are only necessary for first time patients.


Infectious Disease Screening - To be completed by all patients and visitors during the COVID-19 Pandemic.


Caregivers Affidavit - To be filled out by a relative or caregiver of child prior to the appointment they are attending.


Release of Dental Records - Requesting your child's information from another medical office to be sent to Dr. Palmer's office.


Care After Tooth Removal - Helpful information regarding appropriate care after your child's tooth extraction.


Pre/Post Sedation - A reference guide as to what to expect before and after sedation.


Effective Doses of X-Rays - As a parent, you may be concerned about radiation from the x-rays that your child is receiving. These are some 'fun facts' that really puts things into perspective.


Informed Consent for the Orthodontic Patient - Only necessary for patients receiving orthodontic treatment.


Request and Consent for Pediatric Dental Treatment Form


Office Policies


Notice of Privacy Practices



Levi S. Palmer, DDS

Certified Pediatric Dental Specialist



American Academy of Pediatric Dentistry


Why Choose Our Office?



Our team is dedicated to providing the best care for your child.


We treat each child as if they are our own!


An atmosphere that ensures a fun and relaxing visit for patients and parents including:

- TVs above each dental chair to watch your favorite show

- Games in the waiting area to play

- Prizes at the end of each visit


Provide a dental home for your child and instill good oral health habits in your child.


Dietary Counseling.


On-Call availability for after-hours emergencies.