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Copyright: 2016- 2017 Kevin R. Haley DDS
Patient Forms:
Patient Registration Form:
Health Questionnaire:
Notice of Privacy Practices:
Acknowledgement of Privacy Rights:
Patient Records Request Form:
Please download, print and complete the
Patient Registration Form before coming to the office.
Please download, print and complete the Health
Questionnaire before coming to the office.
Please download, print and read the Notice
of Privacy Practices for your records
Please download, print and complete the
Privacy Acknowledgement Form before coming to our office.
If you would like to request a copy of your patient records,
please download and complete the Patient Records Request Form.
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