Forms

Authorization to Release of Records, Many of the documents that we ask you to fill out when you first come to our office are available here for your convenience. You are welcome to fill them out in advance and then either bring them with you to your first appointment or email them to us in advance at info@drpeterbalega.com.

• Insurance Advisory
• Adult Medical – Dental History Form
• Emergency Information
• Financial Policy Acknowledgment
• HIPAA Privacy Policy
• New Patient Registration Form
• Pediatric Medical – Dental History Form
• HIPAA Notice Of Privacy Practices