Patient Forms

Downloadable patient forms that you can print and fill out before your next visit to Ashley Burns DDS in Midland.

We like to make things easy for our patients, which is why we have provided downloadable PDFs of our most common patient forms. To save you time on your next visit to our Midland dental office, feel free to print and fill out the appropriate forms. We look forward to seeing you soon.

Downloadable Forms

• Patient Registration [PDF]
• Medical History [PDF]
• Dental History [PDF]
• Consent for Treatment [PDF]
• Notice of Privacy Practices [PDF]
• Credit Card Authorization [PDF]
• Cancellation and Broken Appointment Policy [PDF]