{"id":1651,"date":"2014-11-23T20:44:50","date_gmt":"2014-11-24T05:44:50","guid":{"rendered":"https:\/\/www.anchoragesmiles.com\/staging\/?page_id=1651"},"modified":"2025-10-13T09:38:17","modified_gmt":"2025-10-13T17:38:17","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/www.anchoragesmiles.com\/patient-forms\/","title":{"rendered":"Patient Information"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last\" style=\"--awb-bg-size:cover;--awb-margin-bottom:0px;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\"><div class=\"fusion-text fusion-text-1\"><p>For your convenience, we have made our new patient forms available to you online via a secure, encrypted connection. These forms are in compliance with the latest HIPAA privacy standards.<\/p>\n<\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"margin-left: auto;margin-right: auto;margin-top:20px;margin-bottom:40px;width:100%;\"><div class=\"fusion-separator-border sep-single sep-solid\" style=\"--awb-height:20px;--awb-amount:20px;border-color:#e0dede;border-top-width:1px;\"><\/div><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last center\" style=\"--awb-bg-size:cover;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\"><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-0 fusion_builder_column_inner_1_3 1_3 fusion-one-third fusion-column-first\" style=\"--awb-bg-size:cover;width:33.333333333333%;width:calc(33.333333333333% - ( ( 4% + 4% ) * 0.33333333333333 ) );margin-right: 4%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-button-wrapper fusion-alignleft\"><a class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-1 fusion-button-default-span fusion-button-default-type button-lca_custom_2\" target=\"_self\" href=\"https:\/\/anchoragesmiles.intakeq.com\/new\/jeacrd\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">TMJ QUESTIONNAIRE<\/span><\/a><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-1 fusion_builder_column_inner_1_3 1_3 fusion-one-third\" style=\"--awb-bg-size:cover;width:33.333333333333%;width:calc(33.333333333333% - ( ( 4% + 4% ) * 0.33333333333333 ) );margin-right: 4%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-button-wrapper fusion-alignleft\"><a class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-2 fusion-button-default-span fusion-button-default-type button-lca_custom_2\" target=\"_self\" href=\"https:\/\/www.anchoragesmiles.com\/financing-insurance\/\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">FINANCING &amp; INSURANCE<\/span><\/a><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-2 fusion_builder_column_inner_1_3 1_3 fusion-one-third fusion-column-last\" style=\"--awb-bg-size:cover;width:33.333333333333%;width:calc(33.333333333333% - ( ( 4% + 4% ) * 0.33333333333333 ) );\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-button-wrapper fusion-alignright\"><a class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-3 fusion-button-default-span fusion-button-default-type button-lca_custom_2\" target=\"_self\" href=\"https:\/\/anchoragesmiles.intakeq.com\/new\/g9JpKR\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">NEW PATIENT FORMS<\/span><\/a><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"margin-left: auto;margin-right: auto;margin-top:10px;width:100%;\"><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-text fusion-text-2\"><p>Welcome to our <a href=\"https:\/\/www.anchoragesmiles.com\/\">Anchorage dental office<\/a>! We\u2019re excited to serve you and want to ensure that your experience with us is as comfortable and personalized as possible. To help us provide the best care tailored to your needs, we\u2019ll ask you a few simple questions about your dental and medical history, as well as any medications or allergies you may have.<\/p>\n<p>For new patients, this information is essential for us to offer top-quality care, including options such as dental implants, <a href=\"https:\/\/www.anchoragesmiles.com\/services\/cosmetic-dentistry\/\">cosmetic dentistry<\/a>, and <a href=\"https:\/\/www.anchoragesmiles.com\/services\/tmj-disorders\/\">TMJ treatment<\/a>. To get started quickly, we also request your contact and insurance details, along with your consent for treatment and photo releases, which are all conveniently included in this form.<\/p>\n<p>Whether you&#8217;re seeking <a href=\"https:\/\/www.anchoragesmiles.com\/services\/full-mouth-reconstruction\/\">restorative dentistry<\/a>, <a href=\"https:\/\/www.anchoragesmiles.com\/services\/dental-implants\/\">dental implants<\/a>, or cosmetic treatments, we\u2019re committed to giving you the highest standard of care at our Anchorage office. We look forward to making your visit both comfortable and effective.<\/p>\n<p>Please remember to complete these forms 48 hours prior to your first appointment. If you have any problems filling out these forms, please call our office at <a href=\"tel:9073490022\" >(907) 349-0022<\/a> for further assistance.<\/p>\n<\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"margin-left: auto;margin-right: auto;margin-top:20px;width:100%;\"><div class=\"fusion-separator-border sep-single sep-solid\" style=\"--awb-height:20px;--awb-amount:20px;border-color:#e0dede;border-top-width:1px;\"><\/div><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last center\" style=\"--awb-bg-size:cover;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\"><div class=\"fusion-text fusion-text-3\"><p>For a full description of how we use patient information, please view our:<\/p>\n<\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"margin-left: auto;margin-right: auto;margin-bottom:10px;width:100%;\"><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-button-wrapper fusion-aligncenter\"><a class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-4 fusion-button-default-span fusion-button-default-type button-lca_custom_2\" target=\"_blank\" rel=\"noopener noreferrer\" href=\"\/x\/lc-content\/uploads\/hipaa-privacy-notice2014.pdf\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Notice of Privacy Practices<\/span><\/a><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":40,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-1651","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Patient Information and Forms | Dr. Kendall Skinner<\/title>\n<meta name=\"description\" content=\"If you&#039;d like to fill out our new patient forms before you visit, or you&#039;d like more information pertaining to patients, we provide everything you need.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.anchoragesmiles.com\/patient-forms\/\" \/>\n<meta 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