Online Patient Forms

Due to recent events with COVID19 virus outbreak all patient forms must be completed online prior to your appointment. 

Please complete ALL (4) forms listed below 

Patient History Form 

Financial Policy Form

Notice Of Privacy Practice Acknowledgement Form

COVID-19 Pandemic Emergency Dental Treatment Consent Form

This site uses 256 bit encryption and is fully HIPAA compliant.  Information submitted on the forms is encrypted in transit and at rest.

Endodontic Partners Notice of Privacy Practices

Click on the link above to review our Notice of Privacy Practices

AT ENDODONTIC PARTNERS WE ARE TAKING EVERY PREVENTIVE MEASURE NECESSARY TO LIMIT THE EXPOSURE OF ANY VIRUS WITHIN OUR OFFICE, AND WE ASK THAT YOU HELP US BY PARTICIPATING IN THESE SAFEGUARDS.

IF YOU ARE CURRENTLY EXPERIENCING A RUNNY NOSE, FEVER, COUGH, DIFFICULTY BREATHING, OR HAVE BEEN EXPOSED TO THE COVID-19 VIRUS, DO NOT VISIT OUR OFFICE UNTIL FURTHER NOTICE.

IF YOU ARE SHOWING/EXPERIENCING ANY OF ABOVE SYMPTOMS, NOT FEELING WELL, HAVE BEEN EXPOSED, OR WOULD LIKE TO RESCHEDULE IN GENERAL, PLEASE CALL OUR OFFICE
Lutherville 410-821-5553 Bel Air 410-836-7800

TEMPORARY PROTOCOL FOR YOUR UPCOMING APPOINTMENT

1. Please send the patient ONLY into our office for their appointment and have all other family members wait in the car. Minors may be accompanied by one parent or guardian.

2. Patients showing symptoms of the flu or upper respiratory illness WILL be asked to put on a mask and reschedule their appointment.

3. Please inform us of any recent travel outside of the U.S. to areas considered Level 3 precaution by the CDC. These areas include Italy, South Korea, Iran and China (as of March 5, 2020). Please also inform us of any recent travel within the U.S. If you traveled internationally within the last 2 weeks, please reschedule your appointment 14 days after your return date.

4. We will eliminate the use of the iPad/Tablet for check in, all patient forms must be completed online prior to your appointment. All forms can be found on our website.

5. Please use the hand sanitizer dispenser in our waiting room upon your arrival, and prior to leaving our office after your appointment.

6. We are eliminating magazines and coffee bar in our waiting rooms for the protection of our patients.

7. The office staff will call patient after the appointment to review treatment if you request them to do so.

8. Please note that we will be limiting social distance, including handshaking, as a means of decreasing possible transmission of Coronavirus (COVID-19).

WE THANK YOU FOR DOING YOUR PART TO HELP THE GREATER GOOD OF OUR COMMUNITY.

Endodontic Partners 

We hope that our website helps answer your questions regarding endodontic dental care. However, please feel free to contact us if something is left unclear  Lutherville-Timonium 410-821-5553, Bel Air Office 410-836-7800.