Patient Forms
Dentist in Savannah
Existing Patient Forms
New Patient Forms
Please use the link below to complete our secure online forms prior to your first appointment. This will allow the new patient process to run more quickly and smoothly both for our practice and for you.
Our Savannah dental team will take comprehensive records and address any concerns or questions you may have. If you have any problems accessing the forms, please contact our office and we will gladly send them to you.
New Patient Forms Online
Records Release Request Online
New Patient Forms – Download/ Print
Records Release Request
Special Needs Patient Forms
We are happy to welcome our patients with special needs.
Please use the links below to complete our Special Needs New Patient Registration and Records Release Request so we can best accommodate your needs. Thank you.
Special Needs New Patient Registration – Download/ Print
PRE SURGERY INSTRUCTION CHECK LIST ONCE YOUR OR DATE HAS BEEN ASSIGNED—THE STEPS BELOW MUST BE COMPLETED OR YOUR OR CASE WILL BE CANCELED
- Confirm copies of all medical/dental insurance cards are on file with our office.
- Schedule Outpatient History and Physical appointment with the Primary Care Physician. This appointment is needed to clear the patient to receive anesthesia The appointment date must be no more than 30 days prior to the surgery date.
- Contact the office of Dr. Berwitz to provide Outpatient History and Physical appointment date. The office can be reached at 912-355-5004 or you can email the date to anna@stevenberwitzdmd.com
- Print out the SPECIAL NEEDS PRE-SURGERY FORMS: HISTORY AND PHYSICAL packet and write the patient’s name and date of birth on the DAY SURGERY / HISTORY AND PHYSICAL FORM. Bring these forms with you to the patient’s clearance appointment.
- Have the Primary Care Doctor complete and sign the LEFT-HAND column of the form. Please request a copy of the patient’s clinical note before you leave the appointment.
- Please make sure the patient’s name and date of birth are written on all paperwork. Please fax or email a copy of the signed Outpatient and Physical form to Dr. Berwitz at 912-525-1973 or email them to anna@stevenberwitzdmd.com. The original signed Outpatient and History form should be returned to the patient. The patient should bring their copy of the completed History and Physical Form to Day Surgery on the day of treatment.
- It is the Caregivers responsibility to make sure all paperwork is completed and submitted to our office per the timeline above. IF YOUR PAPERWORK IS NOT RECEIVED BY THE FRIDAY BEFORE YOUR SURGERY DATE YOUR APPOINTMENT WILL BE CANCELLED.
- The hospital will call you the day before surgery by 6pm with your assigned arrival time.
- On the day of surgery, the anesthesiologist will evaluate the patient and complete the RIGHT column of the Outpatient History and Physical form.
SPECIAL NEEDS PRE-SURGERY FORMS: HISTORY AND PHYSICAL
