My Simon Dentistry - Patient Forms

Patient Forms

To save time on the day of your appointment, please fill out these forms and bring them with you:

Patient Medical History Form (PDF)
Smile Questionnaire (PDF)
Privacy Policy (PDF)
Acknowledgement of Receipt of Privacy Policy (PDF)
Release of Records (PDF)

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

Testimonials

Dear Mitchell,

I received your letter advising that a certain Dr. Matthew Simon was joining your practice. Warm congratulations to you and your wife. How proud you must be of your son's superior background, accomplishment, and personal values. I look forward to meeting him on my next visit. As I read the letter, I could not help but reflect on my first visit a number of years ago to a young dentist recently out of dental school whose talent and appealing personality became quickly obvious to me and many others. His name was, I think, Mitchell Simon. Still is.

Richard

Dear Dr. Matthew Simon and Staff,

Thank you all for the kindness and patience you always give to Anthony. I wish there were more people in the world like you. Heartfelt Thanks

Linda