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Call Us Today!
(817) 238-6450
Call Us Today!
(817) 238-6450

Patient Forms

New Patient Forms

New patient?  We've got a few forms you can fill out at home to make your visit quicker and more painless.

Patient Medical History Form

First time visiting our office?  Welcome and thanks for choosing Serengeti Smiles!  To make your first visit easier please download and fill out our new patient form and bring it with you.

File

New Patient Form

Download File

Privacy Notice

Please read over and sign our Notice of Privacy Practices, acknowledging our privacy policy. This form should also be brought to your first appointment.

File

Notice of Privacy Practices

Download File

Returning Patient Forms

Returning for another adventure?  Welcome back, we've got a few travel documents to fill out at home to make visit quicker.


Records Update Form

Have you had any changes to your child's health, medications, address, or insurance plan? Please fill out our records update form and bring it with you.

File

Records Update Form

Download File

Medicaid Patients Under 3 Years of Age

For our medicaid patients under three years of age; please fill out the following two forms and bring them in as well.

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Medicaid Questionnaire Pt. 1

Download File
File

Medicaid Questionnaire Pt. 2

Download File

Make an Appointment Today!

Call us anytime at:
(817) 238-6450

7109 Navajo Trail
Lake Worth, Texas 76135