Office Business Forms

RELEASE OF CLAIMS FORM

E-mail addressPlease enter your E-mail addressPlease enter a valid E-mail address

Credit Card

Please enter your Credit CardPlease enter a valid Credit Card

Shipping Information

NamePlease enter your NamePlease enter a valid Name

Address Line 1Please enter your Address Line 1Please enter a valid Address Line 1

Address Line 2Please enter your Address Line 2Please enter a valid Address Line 2

CityPlease enter your CityPlease enter a valid City

CountryPlease enter your CountryPlease enter a valid Country

StatePlease enter your StatePlease enter a valid State

Zip CodePlease enter your Zip CodePlease enter a valid Zip Code

If you are human, leave this blank.

RELEASE RECORDS AUTHORIZATION

E-mail addressPlease enter your E-mail addressPlease enter a valid E-mail address

Credit Card

Please enter your Credit CardPlease enter a valid Credit Card

Shipping Information

NamePlease enter your NamePlease enter a valid Name

Address Line 1Please enter your Address Line 1Please enter a valid Address Line 1

Address Line 2Please enter your Address Line 2Please enter a valid Address Line 2

CityPlease enter your CityPlease enter a valid City

CountryPlease enter your CountryPlease enter a valid Country

StatePlease enter your StatePlease enter a valid State

Zip CodePlease enter your Zip CodePlease enter a valid Zip Code

If you are human, leave this blank.

RESPONSE TO PATIENT RECORDS REQUEST

E-mail addressPlease enter your E-mail addressPlease enter a valid E-mail address

Credit Card

Please enter your Credit CardPlease enter a valid Credit Card

Shipping Information

NamePlease enter your NamePlease enter a valid Name

Address Line 1Please enter your Address Line 1Please enter a valid Address Line 1

Address Line 2Please enter your Address Line 2Please enter a valid Address Line 2

CityPlease enter your CityPlease enter a valid City

CountryPlease enter your CountryPlease enter a valid Country

StatePlease enter your StatePlease enter a valid State

Zip CodePlease enter your Zip CodePlease enter a valid Zip Code

If you are human, leave this blank.

PATIENT PHOTO RELEASE

E-mail addressPlease enter your E-mail addressPlease enter a valid E-mail address

Credit Card

Please enter your Credit CardPlease enter a valid Credit Card

Shipping Information

NamePlease enter your NamePlease enter a valid Name

Address Line 1Please enter your Address Line 1Please enter a valid Address Line 1

Address Line 2Please enter your Address Line 2Please enter a valid Address Line 2

CityPlease enter your CityPlease enter a valid City

CountryPlease enter your CountryPlease enter a valid Country

StatePlease enter your StatePlease enter a valid State

Zip CodePlease enter your Zip CodePlease enter a valid Zip Code

If you are human, leave this blank.

PATIENT REGISTRATION

E-mail addressPlease enter your E-mail addressPlease enter a valid E-mail address

Credit Card

Please enter your Credit CardPlease enter a valid Credit Card

Shipping Information

NamePlease enter your NamePlease enter a valid Name

Address Line 1Please enter your Address Line 1Please enter a valid Address Line 1

Address Line 2Please enter your Address Line 2Please enter a valid Address Line 2

CityPlease enter your CityPlease enter a valid City

CountryPlease enter your CountryPlease enter a valid Country

StatePlease enter your StatePlease enter a valid State

Zip CodePlease enter your Zip CodePlease enter a valid Zip Code

If you are human, leave this blank.

PATIENT OVER-PHONE INTAKE

E-mail addressPlease enter your E-mail addressPlease enter a valid E-mail address

Credit Card

Please enter your Credit CardPlease enter a valid Credit Card

Shipping Information

NamePlease enter your NamePlease enter a valid Name

Address Line 1Please enter your Address Line 1Please enter a valid Address Line 1

Address Line 2Please enter your Address Line 2Please enter a valid Address Line 2

CityPlease enter your CityPlease enter a valid City

CountryPlease enter your CountryPlease enter a valid Country

StatePlease enter your StatePlease enter a valid State

Zip CodePlease enter your Zip CodePlease enter a valid Zip Code

If you are human, leave this blank.

GET COUNSEL.

For 20 years, Boyd W. Shepherd, D.D.S., J.D., has been in the business of keeping track of the the law that regulates the dentists of Texas. He has vast experience from Texas State Board representation at each and every level of the process, litigation, and from day-to-day counsel and guidance to dentists across the state of Texas on issues related to their business operations, Board Rule compliance, risk management, employees, and patients.

Bottom line: Comprehensive legal services for Texas dentists.