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Serving Pittsburgh, PA and Surrounding Areas
412-884-8807
Leslie A Wahl, DDS
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OUR SERVICES
FAMILY DENTISTRY
COSMETIC & RESTORATIVE DENTISTRY
PEDIATRIC DENTISTRY
INSURANCE & PAYMENT PLAN
CONTACT
PATIENT FORMS
PATIENT INFORMATION FORM
MEDICAL HISTORY FORM
OFFICE FINANCIAL POLICY AGREEMENT
COMMUNICATION RELEASE FORM
HIPAA POLICIES
HIPAA ACKNOWLEDGEMENT
HIPAA AUTHORIZED PERSON FORM
AUTHORIZED INDIVIDUALS FOR CHILD (Under 18 Years Old)
PATIENT FORMS
Patient Forms
Patient Forms
This is a list of all of our office forms. New patients please fill out all forms prior to your appointment.
Patient Information Form
Medical History
Office Financial Policy Agreement
Communications Release
HIPAA Policies
(print for your own records)
HIPAA Acknowledgement
HIPAA Authorized Persons
Authorized Individuals for Child (only needs to be filled out if patients is under 18 years old)
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412-884-8807
412-884-8807
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