Mike Pulido, D.D.S. | 8590 Farmington Blvd.; Ste. 5 | Germantown, TN 38139 | Tel: (901) 756-0688 | Fax: (901) 756-0838 ©2015 Mike Pulido, D.D.S.
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Current Patient Forms

Please Complete all Patient Forms that you need to update and bring them with you to your appointment.  If you have them completed, we ask that you arrive 5 minutes before your appointment so that we can get all of the information updated in our system and ready for your appointment. Patient Registration Form (Please bring in a completed copy if it has been more than 2 years since your last visit) Patient Consent for Use and Disclosure of Health Information (Must be completed every 2 years) Oral Cancer Screening: Once a year you will be given this form to complete and designate whether or not you would like an Oral Cancer Screening to be performed in addition to your periodic oral evaluation. Account Change Request Form: If you would like to add or remove someone from your account. Dental Records Release Form: In order for us to release your dental records to you or another doctor, we must have this completed form on file.  This is to insure that your personal information is protected. Understanding Your Insurance Handout