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Patient Forms
At Melanie Pugh Cosmetic Dentistry in Bonita Springs, our goal is for you to receive the dental service you need as conveniently as possible.

To save yourself some time on the first appointment, you can fill out our patient forms at home. Download and print our patient forms here. If you have any questions, please feel free to call our office.

New Patient Forms
New Patient Form

Medical History Form

HIPAA Consent Form

Patient Questionnaire

Patient Release Forms
Authorization to Release Dental Records

Non Dentist Of Record Form

Affidavit for Intolerance to CPAP

Appointment of Representative Form

Melanie Pugh, DMD
7138 Highland Drive, Ste #218 Cottonwood Heights, UT 84121
Phone: (801) 944-9494