Welcome to South Hills Dental Arts Forms Portal!

For your convenience, we have the necessary forms for your upcoming appointment accessible below. We require ALL patients to complete these forms prior to any appointment.

New Patients:

Medical, Patient Info, Insurance, HIPAA, and COVID.

Hygiene Wellness Appointments:

Medical History.

Existing Patient:

Once a year, please update all of the forms listed below.

  • Medical History: A patient’s physical state and medical history can determine the course of treatment and care. By knowing your medical history, it allows us to customize your future treatment to what will work for you specifically. For existing patients, your medical history MUST be filled out prior to every hygiene appointment.
  • Patient Information means any and all information or data regarding a patient including information relating to his or her identity, demographic profile, health status
  • HIPAA-- The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge.
  • HIPAA is important because it ensures healthcare providers, health plans, healthcare clearinghouses, and business associates of HIPAA-covered entities must implement multiple safeguards to protect sensitive personal and health information.
  • COVID -- This form is a required form that needs to be signed and documented that you are granting us permission to treat you during the COVID-19 Pandemic. (New Patients)
  • Insurance -- Even though this information was gathered over the phone, we need a document stating that we have verified the information given.

Medical history should be updated at every hygiene appointment i.e. prophy and perio therapy

Ingram, PA

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