Welcome to our patient information page at Pediatric Dental Specialist!
Dr. Stephen P. Girdlestone in Canton, Ohio.
Please download, print and fill out the New Patient Packet before your first appointment, this will minimize your time spent in our waiting room.
New Patient Packet contains the following three forms:
- Patient Admit Form
- Medical History
- Financial Policy
- Acknowledgement of Receipt of Notice of Privacy Practices
Authorization for Release of Dental Records and X-rays
Dental Risk Assessment Questionnaire
Dr. Girdlestone OR Packet for Hospitals
Financial Policy – Financial Policy Pediatric Dental Specialist PDF Download
HIPAA Notice of Privacy Practices