Dental History and Insurance Form

Please download our New Patient form and HIPPA form and submit prior to your visit, or bring it with you during your initial consultation.

Just select the image to the left and download the form for completion.

HIPPA Form

Please return to:

Fax: 512.373.3408 or
Email: smiles@authenticsmiles.com

Finally a wonderful Austin dentist!!!!!!!!! – September 19, 2011
I have only been in Austin for 3 yrs and have been looking for a dentist since then. Having a tooth pulled after 40 yrs was a very scary thing to do. Thank you for being kind and gentle with me. I know this is the start of a great patient/dentist relationship.