Call or text us at (785)266-4412 ~ Email us at info@thetoothfairytopeka.com
Call or text us at (785)266-4412 ~ Email us at info@thetoothfairytopeka.com
If this will be the first time this patient is seen in our office, follow the link to the New Patient Forms section
If the patient has been seen in our office, but needs to update forms, follow the link to the Current Patient Forms section
Need records sent to another office? Or to give permission for your older child to come to the appointment without a parent/guardian? Follow this link to the Other Forms section.
Follow this link for online fillable patient forms
Click the link above for secure online fillable forms. If you would rather print the paperwork, the PDF files are below.
*Note, we are not currently accepting new adult patients at this time*
Follow this link for forms for current patients
Click the link above for secure online fillable forms. If you would rather print the paperwork, the PDF files are below.
Release for Patients Over Age 18 to Allow Information to be Shared with Parents
Consent to Treat Child Under Age 18 Without Parent Being Present
Request for Our Office to Release Records to a New Office
Request for Previous Office to Release Records to Us
The above links allow for filling out paperwork online through our secure portal. If you would rather print the paperwork, please choose from the following PDF files, print, and bring with you to the appointment.
The Tooth Fairy
1230 SW Harvey Street
Copyright © 2023 The Tooth Fairy - All Rights Reserved.
Powered by GoDaddy
We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.