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Patient Forms


Welcome to Gentle Dental-care Relaxation Clinique, where beautiful and healthy smile begins.

We have convenient hours (8:00 a.m. – 6:00 p.m. Mon. – Fri.; and 8:00 a.m. – 1:00 p.m. on Sat.) to fit your busy schedule, as well as convenient free parking. We accept most dental insurance plans and will be happy help you obtain your maximum insurance benefits. We accept cash, check and credit card payments, and provide third party easy payment plans.

For convenience, we have provided the American Dental Association, (ADA) approved dental forms to be completed by new patients and taken (along with former x-ray records) on the first dental appointment. To prevent delays during this appointment, it is very important that new patients provide all the information requested. These information are necessary for the assessment of general health history and dental diagnosis; processing insurance claims; and establishing personal billing accounts and identity.

As we are aware of the current “identity theft” scares, you can be assured that all private medical/dental records are secured under the health profession’s strict standards and guidelines required by the Maryland State Dental Association and local State Laws. If the patient is a minor, please provide  the Social Security number (SS#) of the insurance subscriber and/or parent/guardian responsible for the account. However, we respect the choice of those patients who prefer nondisclosure of their Social Security number (SS#), but be advised that we would not be able to process insurance claims and/or establish a personal billing account without an  identification number. Consequently, at the appointment when treatment services are rendered, full payment (in cash and/or credit card only) will be required. 

Our goal is to professionally serve you in the most convenient and respectful manner, with your thoughtful assistance. Thank you for your cooperation.

Remember, looking and feeling your best start with a beautiful and healthy smile! Come and experience the ways we care!

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

Click Below To Print Out Patient Forms

Sincerely,

Gentle Dental-care Relaxation Clinique
NORMA FOX, D.D.S., P.A.








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