Patient Forms

The first appointment at a new dental office can make for a busy day. This is especially true if you are brining your children to Summit Family Dental for their first visit with our dentists. Dr. Cody Coleman, Aaron Rasmussen, Chris Giblette and associates, want your dental appointment in Kirtland, Rio Rancho and Farmington, New Mexico, and Cortez, Colorado, to be as stress-free as possible and we have provided access to our patient forms on this page. You can print out your forms, complete them and bring them with you to our office, or you can fill them out online using the Google Chrome browser and securely submit them to our office. Completing your paperwork before your visit will give you one less thing to do and allow you to spend less time in our waiting room and instead, relax and focus on getting the smile you have always wanted. If you have questions or would like to schedule your visit, call our office today.

For Patients

HIPAA Privacy Practices

Kirtland Office

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Farmington Office

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Cortez Office

Medical Dental History
New Patient Registration
Financial Cancellation Policy
Notice of Privacy Practices and Patient Consent