Patient Forms

New and Existing Patient Forms

New Patients of Glen Lake Family Dentistry:

Please complete the forms below prior to your appointment to save you some time.  You may email them to: or bring them with you to your appointment.


Authorization to Release Dental Records

Release of Dental Information

HIPAA Consent

Medical History Form 

Glen Lake Family Dentistry Affordable Care Act

For more information, call us  at (952) 938-6038 or Schedule an Appointment now!