New Patient Intake Form


Please Click the button to download our New Patient Intake Form and email it back to us or bring it with you on your first visit. ***Alert: For the safety of your child and due to new regulations, if you must fill out the Complete Medical History for each child, please download and fill out the following form for each of your children and bring it with you at your visit.***
Click to Download Form

We are delighted to welcome you and your child into our practice. We’ve been providing high quality pediatric dental care for infants, children, and teens throughout Houston for over 30 years. In the practice of “pediatric dentistry,” we have office routines that are uniquely different than what you may have been accustomed to in general dentistry practice. These differences set us apart and make us highly qualified to meet the needs of your children. For you and your child to feel more “at home,” we would like to familiarize you with our practice.

At the first visit, you will be asked to complete a medical and personal history questionnaire for your child. These questionnaires allow us to become more familiar with your family as well as ensure that we understand your child’s important medical and dental history. We will then acquaint your child with our dental office, the teeth will be cleaned and polished and we will perform a complete oral examination. The examination may, depending on age, include dental x-rays. Everything that we intend to do for your child will be explained and demonstrated before we do it. This is very important in helping your child understand the dental visit process.

We prefer that a parent, legal guardian or custodial caregiver accompany your child to all visits. If an adult other than you will be bringing your child, it is necessary to have a signed letter or our transfer of authority form. This form, when signed, provides the accompanying adult permission to make dental decisions for your child on your behalf. If you know you will not be accompanying your child please let us know ahead of time and we can advise you on writing a letter or filling out the transfer of authority form.

At the completion of the initial examination visit, your child’s oral health status and necessary treatment will be discussed with you by one of our dentists. This consultation is designed for you to be able to speak one on one with the pediatric dentist and gain a full understanding of your child’s oral health. As your children’s dentist we are committed to partnering with you and want your participation in determining what dental treatment is best for your child. Please feel free to ask any questions.

We have found that many children are genuinely cooperative and we consistently establish a closer rapport if parents remain in the waiting room during examination and treatment visits. While we appreciate your cooperation in this matter, exceptions are always made especially for young children, apprehensive children and children who haven’t had the benefit of a successful dental experience in a setting as professional as ours. Our dental team is experienced and proficient in helping children overcome apprehension. Should you have any concerns or have any additional insight in how to best gain the trust of your child please do not hesitate to make us aware on the day of your appointment. One of our prime objectives is to help your children develop into good dental patients who will be able to receive dental care with positive attitudes. This process can begin at home prior to the first visit.

 

Here are some suggestions to aid you:

1. Make the appointment day as easy as possible and try to see that your child is well rested.

2. It is best to tell a young child about a dental visit the day of the appointment.

3. If your child requires more information, you can say,
“The dentist will look at your teeth to make sure they are healthy.”

4. Try to convey the feeling that dental visits are a normal part of growing up.

(Sometimes the promise of a reward for “going to the dentist” inadvertently implies that there is something to fear.)

5. Of course, always avoid the threat of a dental visit as punishment for misbehavior.

At Urbach Pediatric Dentistry we are committed to a policy of prevention. By seeing children early in life we can often reduce the incidence of dental decay and infections with early preventative treatment techniques. Recognition and early treatment planning of developing orthodontic problems often enable us to either correct the problem or lessen the severity of the problem, thereby resulting in much better long-term results. Your child, with our help and your participation, can become an excellent dental patient with a healthy mouth and a confident smile.



  • Facebook
  • Google+
  • Twitter
  • Yelp
  • Angies List
  • YouTube