Forms and Documents


If you are a new patient or a patient of records and want to make an appointment easily, fill out our online submission for your appointment and a scheduling coordinator will contact you to complete and verify your appointment. You will find referral forms for Drs. Freedman, Weitman, and Rahman that you can submit online with no hassle, no paper, and a reduced environmental cost. If you have never been seen at our practice please print, fill out and bring the appropriate new patient forms with you to your first appointment to save yourself time. 

 


Appointment Request Form

 

Patient's Name *
Patient's Name
The name of the patient visiting the practice
Phone Number
Phone Number
The best number to contact you
What are your preferred days for appoitments?
Are you a new patient to our practice?

Comment Form

Name *
Name
Were you please at how quickly you were able to schedule your appointment?
How pleased were you with the appearance and cleanliness of our office?
5 = the very satisfied, 1 = unsatisfied
Did you feel like your dentist fully explained your treatment plan and treatment options?
Are there any areas in which our services, staff, or doctors can improve?
Our practice values happy, satisfied patients and our success is based on our patients' recommendations. Would you refer your friends and family to us?

Refer a Friend

Your Name *
Your Name
Best number to reach you
Refered Patient Information
Name of person you are referring
Name of person you are referring
Referred Patient Phone Number *
Referred Patient Phone Number

Doctor Referral

 

Your Name *
Your Name
Your Phone Number
Your Phone Number
Referred Patients Information
Referred Patients Name:
Referred Patients Name:
Referred Patients Phone Number:
Referred Patients Phone Number:
Best contact number
Have you or are you going to send the patient records?

 

New Patient Forms

If you are a new patient to Drs. Freedman, Freedman, Weitman, or Rahman you can now download our initial patient paperwork. Conveniently download, print, and fill out all the paper work at home and bring in with you at your initial appointment.

CLICK THE CORRECT FILE BELOW

Adult Health History Form  

Child Health History Form