For your convenience, you may print out the any of the patient forms listed below and fill them out at your own pace, from the comfort of your own home. Then just fax them to us or bring them in with you when you visit us for your scheduled dental appointment.  

 

New Patient Form

Record Release Form

HIPPA  Privacy Statment

HIPPA Consent Form

 

 If you have any questions regarding any of these forms, please feel free to contact us. 


Charles R. Fana Jr., DMD PC
General & Cosmetic Dentistry
314 Stephenson Avenue
Savannah, GA  31405
Phone: (912) 352-3955