Patient Forms
In order for Dr. Patino to diagnose your dental status, we need to obtain accurate information from you…always kept confidential. The following forms are required at your initial visit. You may complete them at your leisure prior to our first appointment.
Privacy Acknowledgement
In order to view or print these forms you will need Adobe Acrobat Reader installed. 
Dr. Patino is an indirect dental provider to several insurance carriers.
We will gladly assist you with insurance estimates and filing.
Keep in mind that dental insurance coverage can vary from medical.
Please contact your carrier to better understand your insurance policy.
We accept payments at the time of service.
The following forms are appreciated:
Personal Checks, Cash, Debit, Visa, Mastercard, & Discover.
Elizabeth Patino, DMD, PA does not finance payments, instead we
work with local financial companies for your convenience. Currently,
you can take advantage of 3 month same as cash options or use their
low interest payment plans.
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