Anthony J. Hornaday, D.D.S.

                                Oral and Maxillofacial Surgery

                           of East Central Indiana

                                         620 S. Tillotson Ave.    Muncie, IN 47304   (765) 289-9705  ♦  E-mail: hornaday@hornadayoms.com

 

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Please feel free to download, print, and fill these forms out prior to your appointment.

 
If you are a new patient or it has been over a year since you have been to our office,
you will need to download, read, complete, and sign all of the following forms:
 
bulletPatient and Insurance Information
bulletSecondary Insurance Information (if needed)
bulletMedical History
bulletFinancial Policy
bulletHIPAA Privacy Policy
bulletHIPAA Consent for Use and Disclosure
bullet HIPAA Acknowledgement of Receipt of Privacy Practices
bulletPost Operative Instructions
 
 
If you know which procedure you are having, you may print, read,
and sign the appropriate Consent Form below and bring with you to your appointment:
 
bulletConsent for Extractions
bulletConsent for Implant Placement
bulletConsent for Exposure and Bracketing of Impacted Teeth
bulletConsent for Treatment of Facial Fractures
bulletConsent for Oral Surgery and Biopsy

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Last modified: 09/09/10