New Patient Forms

Please Print and fill out the following forms and bring them with you to your “New Patient” appointment. If you have any questions regarding paper work or policies don’t hesitate to give the office a call at (406) 892-2104 and one of staff will be happy to assist you. Like yours, our time is valuable, so if you need to reschedule your appointment please call at least 24 hours in advance to make any changes.

Please click the links below to print the following patient forms:

• New Patient Packet

• Financial Statement

• Notice of Privacy Practices

• Record Release

• HIPPA


Urgent Dental Care Forms

Please Print and fill out the following forms and bring them with you to your “Urgent Care New Patient” appointment. If you have any questions regarding paper work or policies don’t hesitate to give the office a call at (406) 314-6353 and one of staff will be happy to assist you. Like yours, our time is valuable, so if you need to reschedule your appointment please call at least 24 hours in advance to make any changes.

Please print and complete the following patient forms prior to your appointment:

Patient Information

Authorization to Disclose Protected Health Information


Payment Options

We accept payment by Cash, Check, Debit, American Express, Discover, MasterCard, VISA or CareCredit

Thank you for choosing Smile Montana Dental Center!