Patient Information and Forms
at Heritage Lake Dental
in Valparaiso & Merrillville

Patient Forms

If you are a new patient to our family dentistry office, the attached links contain the forms you will need to be filled out before you arrive for your appointment. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than if you complete them after you arrive. Thank you and please call our office if you have any questions at all.

new dental patient history form

New Patient History Form

Click the form for a printable PDF

dental health history form

Dental Health History Form

Click the form for a printable PDF

medical history form

Medical History Form

Click the form for a printable PDF

hippa consent form

HIPPA Consent Form

Click the form for a printable PDF

For more information about our practice, dental treatment options, payment options, or any of the services we provide, call our Valparaiso office at 219-464-1141 or our Merrillville office at 219-769-8788. We look forward to serving your dental care needs.