Please read, complete, print and sign the following pages and bring with you to your appointment. The Hippa Privacy Act Notice is at the bottom and may be kept after reading.
The following are forms for new patients. If you wish, you can print them from your computer, fill them out, and bring them when you come for your first visit. We also have copies available at our office. Click the icon to download the type of file you prefer.
Patient Forms |
Word | |
| Patient Introduction |  |
 |
| Patient Health History | |
|
| Office Policies and Procedures | |
|
| Consent Form for Endodontic Treatment | |
|
| Consent Form for Endodontic Surgery | |
|
| Receipt of the Privacy Act Notice | |
|
| Hippa Privacy Act Notice | |
|
Dr. Harmon is a top Endodontic Specialist proudly serving the Northshore, Southshore, Mississippi Gulf Coast, Southeast Louisiana, St Tammany parish, Orleans parish, Jefferson parish, Tangipahoa parish, Livingston parish, Baton Rouge, Slidell, Hammond, Lacombe, Pearl River, Kiln, Diamondhead, Carierre, Gulf Port, Metairie, Kenner, New Orleans, New Orleans East, Lakeview, Mid City, Mandeville, Covington, Madisonville, Bush Folsom, Hammond, Denham Springs, Kentwood, Greensburg, Walker, Albany, Amite, Independence, Montpelier, Ponchatoula, Roseland, Springfield, Tickfaw and Greensburg areas.