Patient Forms

To make preparing for your child’s pediatric dental appointment simpler, we provide patient resources to ensure you have access to important information regarding your son or daughter’s procedure:

Patient Forms New Patients Form Medical History Form (Online)

Consent to Treat Patient Without Parent:

Treatment Consent Form

Authorization For Use And Disclosure To Individual(s) Other Than Parent Or Guardian:

Disclosure Authorization Form

Schedule Your Little One’s Appointment

Pediatric Dentistry of Round Rock aims to make your son or daughter’s dental experience a safe and comfortable one by utilizing advanced technology and maintaining flexibility with payment options. Contact our Round Rock, TX office online or by calling (512) 733-5311 to schedule an appointment today.