Patient Forms


Make Your First Visit A Breeze.  Download the Forms Below, Complete Them and Bring Them To Your Appointment.

New Patient Registration Form - Click to Download

Assignment of Benefits Agreement - Click to Download

Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) - Click to Download

Medical History - Click to Download

Notice of Privacy Practice - Click to Download for your personal records

Here at Centerpoint Advanced Restorative and Esthetic Dentistry we really believe in taking the time to get to know each and every one of our patients on a personal level. We want to make sure that we fully understand what it is that you want when it comes to your smile. By working together with you, we will achieve the best result possible. Our goal is to make sure every patient feels appreciated and to make sure to take the time to confirm that we are on the same page every single step of the way. We are proud of our office which fully utilizes state of the art equipment.
We look forward to welcoming you to our beautiful dental office in Richardson.


We accept ALL PPO Insurance Policies. We will bill your insurance companies as a complimentary service. Our Insurance Coordinator will be more than happy to check on your insurance policy for you and answer any questions you may have. Please call our office to make an appointment and we will make sure to take care of everything regarding your insurance for you.

Delta Dental


Centerpoint Advanced Restorative and Esthetic Dentistry
4112 East Renner Road
North Dallas

Richardson, TX 75082
Phone: 972-480-0800
Fax: 972-480-0900

Office Hours

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