HIPAA Notice of Privacy & Acknowledgement of Receipt

Thank you for choosing Liberty Hill Dental! Please complete this form prior to your upcoming appointment. If you have any questions, please contact our office. We look forward to seeing you soon!

If you are a NEW PATIENT, please complete the following forms:

0.1 New Patient Registration
0.2 Medical and Dental History Form
0.3 HIPAA Notice & Acknowledgement
0.4 Office Policies

If you are a RETURNING PATIENT, please complete the following forms:

0.1 Patient Information Update Form

IF YOU ARE COMPLETING YOUR ONLINE FORMS FROM A MOBILE DEVICE, PLEASE ENSURE YOUR WIFI CONNECTION OR CELL SERVICE SIGNAL IS STRONG.