Which forms new patients fill in
Four short forms, completed once and updated when something changes.
Registration
Your name, contact details, emergency contact and how you’d like us to send appointment reminders.
Medical history
Your health conditions, medicines, allergies and any recent surgery.
Dental history and insurance
Past treatment, what’s bothering you now, and your dental plan details.
Consent and privacy
Your consent to an exam and your acknowledgment of how we protect your health information.
Who fills in what
| Patient | What to do |
|---|---|
| New patients | Complete all four forms before your first exam. Arrive 15 minutes early to fill them in at the front desk. |
| Returning patients | Update your details once a year, or whenever your health, medicines, insurance or contact details change. |
| Patients under 18 | A parent or legal guardian completes and signs the forms and comes to the first visit. |
| Emergency visits | A short medical history is needed before treatment, so we can treat you safely. |
Your information stays private
Your forms become part of your dental record. They’re used only for your care and your insurance claims, and protected under HIPAA, the federal law on health information.
Please don’t send medical details through the website’s contact or booking forms. Bring them to your visit or call 845-336-5855. Our privacy policy explains how the website handles information.
Need help with your forms?
Tell us when you book if you’d like large print, help reading or writing, or someone to go through the forms with you. The front desk team is happy to help.
Patient form questions
Patients come to us from Kingston, Port Ewen, Lake Katrine, Hurley, Saugerties and across Ulster County.
Do I have to fill in forms before my first visit?
Yes. Your medical and dental history helps Dr. Ibrahim Sayeed treat you safely, so the forms are completed before your first exam.
Can I fill in the forms before I arrive?
Ask when you book and the team will tell you how. Otherwise, arrive 15 minutes early and fill them in at the front desk.
Why do you need my medical history?
Some conditions and medicines affect bleeding, healing and which numbing or antibiotics are safe for you.
Do returning patients fill in the forms again?
Only to update them: once a year, or sooner if your health, medicines or insurance change.
Can a parent fill in the forms for a teenager?
Yes, and they must. A parent or legal guardian completes and signs the forms for any patient under 18.
