Patient Forms

The following forms are needed for your upcoming appointment.  Please fill out the forms, print them, and bring them to your appointment.  In addition, please bring all referral information from your Doctor, recent X-rays, a complete list of ALL medications and their dosages, and insurance information with you to the appointment.  If you have any questions, or need assistance, please don’t hesitate to call us at 912.354.1515 (Savannah) or 912.748.4365 (Pooler).  We look forward to meeting you!

Patient History – Patient’s medical health history

Patient Information – Patient’s personal and insurance information

Financial Policy – Chatham Oral & Maxillofacial Surgery’s financial policy

Privacy Policy – Notice of privacy practices

Privacy Policy Acknowledgment – Acknowledgement of privacy practices

To view these files

All of the patient forms are in pdf format. You must have Acrobat® Reader® installed to view these forms.