Tim & Romana Kerr, DMD

Tim & Romana Kerr, DMD

Your family dentist in Upper St. Clair, PA

Patient Forms

We are happy to offer our patient forms online. Please feel free to print and fill them out at your convenience before your visit.

New Patient Forms

Please complete these forms before your first dental appointment.

Medical History (49 KB)
HIPAA Form (260 KB)
Acknowledgement of Privacy Practices (290 KB)
Financial Policy (25 KB)

Existing Patient Forms

This form needs to be completed for our zoom whitening service.
Zoom Whitening Information/Consent Form (124 KB)
Patient Payment Agreement (8 KB)

If you are unable to view the pdf files, please click on the icon below to download and install Adobe Reader: