Patient Forms

When your appointment is confirmed, our software lets you complete these forms on your phone. If you prefer paper, download and print them below, or ask for copies at the front desk. Call (703) 451-4500 if you need help with any form. 

• Health and Dental History your medical history, medications, allergies and dental concerns, so Dr. Dulac can plan safe treatment.
• Payment Policy How we bill insurance, when payment is due and the financing options we accept.
• Notice of Privacy Practices (HIPPA) How your health information is protected and used.
• TMJD and Sleep Screening TMJD and Sleep Screening: a short questionnaire about jaw pain, headaches, snoring and sleep, because we screen every patient for sleep apnea.