We include a list of all of the forms and documents that are included in our New Patient Packet. Churney Periodontal has placed these forms online so you have the opportunity to reference them, to read over them before your first appointment, or even print them ahead of time and fill them out.

These forms will always be available to you in our office and there will always be a staff member available to go over the information with you if you have questions or need assistance with the forms.

New Patient Packet

Dr-Churney-Patient-Form

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Notice of Privacy Practices / HIPAA
Notice of Privacy Practices / HIPAA

Click here to view HIPAA Policy Online|
HIPAA, which stands for the American Health Insurance Portability and Accountability Act of 1996, is a set of rules to be followed by doctors, hospitals and other health care providers. HIPAA took effect on April 14, 2006. HIPAA helps ensure that all medical records, medical billing, and patient accounts meet certain consistent standards with regard to documentation, handling and privacy.