Patient Forms


We specialize in pediatric dentistry and as such we have based our practice around making our facilities comfortable and fun for children. However, we want to make things easier on parents as well. Here, we’ll post forms and other documents that we require for our new patients and parents can fill out on their own time. All forms, except the minor consent form, will be filled out upon arrival to the clinic. The minor consent form will need to be filled out in advance.

Minor-Consent Form

Patient Info

Office Financial Policies

Insurance Info

General Consent Form

ADA Covid Screening


Surprise Pediatric Dentistry
15331 W Bell Rd, Suite 112
Surprise, AZ 85374
Phone: 602-730-6481
Fax: 602-730-6482
Office Hours

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