Riverdale Pediatric Dentistry ~ Home of Cavity Patrol.com
First Visit
Routine Care
RPD Policies
FAQ's
Dental Terms
Parent Surveys
Patient Gallery
Fun Activities
Hospital Care

Office
Info

Map &
Directions

Child's
Forms

Office
Tour

Meet The
Staff

Payment
Info

Riverdale Pediatric Dentistry
Child's Forms

All forms except the Doctors Referral Form are required for first-time patients. Click on the links below to print out the appropriate form, complete the form and bring with
you to your appointment. Thank you!

Child's Medical History

Consent To Provide Treatment

Consent For Use and Disclosure of Health Information

Notice of Privacy Practices

Patient Consent For Use and Disclosure of Protected Health Information

Acknowledgement of Receipt of Notice of Privacy Practices

Office Policies for Parents

Doctors Referral Form (doctors only)


Open Weekends &
Evening Hours

Phone: 763-767-1524
Fax: 763-767-1528
Appointments@CavityPatrol.com
Riverdale Pediatric Dentistry
CavityPatrol.com

3585 124th Ave. NW
Suite #400
Coon Rapids, MN 55433

 
©2006-2008 Web Site Created By Management Specialties