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Patient Form Downloads

For your convenience, all new patient forms can be accessed online. Please download and complete each form below prior to your appointment and bring them with you to your first visit. Completing these forms prior to your appointment ensures that we will be able to see you promptly. If you should have any trouble downloading these forms, please call our office and a knowledgeable staff member will assist you.

  Medical History Form: Front & Back 
Consent For Use and Disclosure of Health Information Form 
  Privacy Act Notice 

Dental Implant Consent Form

Periodontal Surgery Consent Form
  LANAP Protocol Consent Form

Pre-Operative Instructions




For a limited time, Dr. Burliss is offering patients a FREE LANAP Consultation if you book your appointment today! 

Call today to schedule your consultation or click the button below to learn more!