New Patient Forms

 
 
 
 

Welcome to The Broward Dental Rejuvenation Center and thank you for choosing us as your partner in dental health!  We would like to make your experience here as convenient as possible.

We are happy to offer our new patient forms online.  Please feel free to print and fill them out at your convenience before your visit.  Bringing your completed forms to your initial visit will save you time.  If you have any questions, please call our office and we would be happy to help you.  We look forward to getting to know you and helping you enjoy a lifetime of healthy smiles.

 
 
 
 

BDRC PATIENT REGISTRATION

BDRC PATIENT AUTHORIZATION DISCLOSURE

BDRC PATIENT HIPPA FORM