Patient Forms

All New Patients:  Please click on each link below to download an Adobe Reader® file of that form.  Bring these forms with you to your first visit along with your insurance card, medication list, and driver’s license or other photo I.D.  Note: If you decide to fill out these forms and then email them back to us, please be aware that you have a choice to either send documents via email (which is not protected) or you can print, complete, and return the forms on-site to our practice.  Our email address is: drmarkbagby@gmail.com.
 
Please DO NOT use email to communicate with us about an urgent medical issue.
If you are experiencing a life threatening situation: Call 9-1-1
If you are not experiencing a life threatening event, but want to contact us about a medical issue, please contact our office by phone during regular business hours.
 
Patient Demographic Info and Financial Release Form
Compound Release of Information Authorization Form
Medical History Form
 
Please print as needed:
HIPAA Notice of Privacy Practices
To have your dental records transferred from our office to a different office, please click HERE
To have your dental records from your previous Dentist sent to our office, please click HERE
 
In order to view or print these forms you will need Adobe Reader installed.    
Click here to download it.
 

Our Locations

Family Dentistry

Saint Joseph Office
2001 Frederick Ave
Saint Joseph, MO 64501

(816) 233-1285
(816) 261-8104


Prairie Village Office
7301 Mission Rd Ste 240  
Prairie Village, KS 66208

(913) 642-1999
(913) 909-8720