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Patient Dental Forms from Dr Bray and Dr Young

Patient Forms

Dental forms are provided for your convenience. Please click on the form below, download, and print to complete.

We accept forms via mail, hand delivery or e-mail prior to your first visit.

Email forms to:

Mailing Address:
2 Lester Court
Statesboro, GA 30458

To download a copy, please use the links below:

Patient Registration Form

Adult Medical and History Form

Dental History for Adolescents and Adults

Child Medical and Dental History Form

Records Release Form

HIPAA Notification of Privacy Policy

1557 OCR Notice of Compliance

1557 OCR Notice of Compliance Cont'd