New Patient Paperwork


Click the following link to download the required forms to complete, sign and return to our office:

New Patient Paperwork – Dr. Mary Day

You may enter your information (name, etc.) in the necessary fields by either typing directly in the boxes, or by printing the forms and filling them out by hand.

After completing the required forms, print, initial, sign & date in the required places. You may either bring the forms with you to your first appointment, fax the completed & signed forms to us at (866) 846-5876.

Notice of Privacy Practices – This notice describes how medical information about you may be used and disclosed and how you can get access to this information.   In the New Patient Paperwork, there is a form for you to sign acknowledging that you have received this notice.

Thank you! We look forward to seeing you in our office soon!

Mary Moran Day, DDS

Starfish Logo - gray