For your convenience, we have provided our patient forms online. We invite you to fill them out before your child’s appointment with Drs. Richard Ruffalo, Molly Lanz, Priyanka Vaddi, or Courtney Uselton. This will save you time in our office and make your experience much smoother. If you have questions about our patient forms or about pediatric dentistry in Pittsburgh, Imperial, and McMurray, Pennsylvania, please contact Pediatric Dentistry South today. We will be happy to help you.

Please open and complete the following forms as instructed by the office. After filling out the entire form, hit the SUBMIT button to have the form sent to our office electronically.

  1. New Patient Welcome
  2. HIPAA Agreement Form
  3. Medical History and Consent Form
  4. Financial Responsibility Form
  5. Privacy Notice
  6. Patient Information Form
  7. Medical History Update (Existing Patients Only)