Forms

Gubler Periodontics provides here the forms we use. Click on the "View Document" tab and print the forms; fill them out and bring them with you to your appointment. This will save time when you arrive at our office.

Print All Forms

Print all required forms for your first visit to Gubler Periodontics.


Patient Information

We ask that you fill out our Patient Information form so that we may get information for billing and insurance. 


Medical Questionnaire

Our Patient Questionnaire form is for new patients to fill out and bring with them to their initial appointment.


HIPAA

This HIPAA (Health Insurance Portability and Accountability Act) form describes your privacy rights as a patient regarding security of electronically protected health information. 



Other Resources

American Academy of Periodontology | perio.org

American Dental Association | ada.org

Utah Dental Association | uda.org

Utah Department of Health | health.utah.gov

Care Credit | carecredit.com