Dr. Harvey Levy & Associates, PC

Quality dental care in Frederick, Maryland since 1980

Voice/TDD: 301-663-8300 ~ appointments@drhlevyassoc.com

Man sadly staring at a pile of paper

Forms for Patients

We too wish there wasn't so much paperwork. Unfortunately we are obliged to subject you to this.

Save yourself 20 minutes at our office -- download, print, and fill out, and date and sign these forms in the comfort of your home. Tips:


(Penalty for forgetting to bring the forms: you'll need to fill them out again at the office.)

New Patient? Download all the forms you need in one file:

Existing Patient? Download whichever of these 4 forms apply to you.

1.  Medical History Update. Update every 6 months or whenever you've had significant changes to your health situation. Please complete, date, and sign.

2.  HIPAA. Update every 1 year or whenever you need to make changes to which people you allow us to contact about your health, or to how we may contact you. Please complete, date, and sign.

HIPAA - Comunication Authorization and Consent for Use and Disclosure of Health Information - 1-page PDF, rev. 1/10/18.

Should you wish to see our full Notice of Privacy Practices, you may download it here (PDF, opens in a separate window.)

3. Financial and Insurance Policy. Please complete, date, and sign if you've not been to our office since May 2, 2016.

4. Dental Claim Form. If you have dental insurance, please submit an update whenever your health insurance situation changes.

 If you've filled out these forms, please deliver them to the Front Desk as soon as you arrive at our office.