Patient Forms

If you are a new patient to our office, the links below contain our new patient forms that will need to be completed before your appointment. There is no printing involved! Please click on the link, fill out the information and hit submit. This will allow us to attend to your medical needs more quickly and allow for faster check-in upon arrival to our office.  Please call our office if you have any questions. Thank you.

The Notice of Privacy Practices is available to print and review.

If you are currently or have been to another dental office- please print out our records release form to fill out and mail before your dental appointment.

Patient Forms (Complete All Forms Prior To First Office Visit) 

ADULT MEDICAL.pdf

CHILD MEDICAL.pdf

RECORDS RELEASE FORM.pdf

Notice of Privacy Practices.pdf

Drs. Timothy DeRuyter, Lindsey Stein
Silver Lake Dental PLLC

Perry and Nunda, New York Dentists at Silver Lake Dental are dedicated to family dentistry such as Exams, Teeth Whitening, Veneers and more.

2024

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114 N. Center StreetPerry, NY 14530Get Directions585-237-3530

2024

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