MacArthur Park Dentistry | Sam S. Koo, DDS | Family and Cosmetic Dentistry | Irving, Las Colinas, Dallas, Texas

Patient Forms
MacArthur Park Dentistry provides the forms below to make your first visit more convenient for you. For faster service, please print and fill out all the forms beforehand and bring them with you when you come in for your appointment.

1. Patient Information. This form will contain your address and contact information, and a brief health history.

2. Office Policy. This form provides information that includes our payment policy, your payment options, insurance claims, and missed appointments. Video: Insurance Information

3. Notice of Privacy Practices Acknowledgement. This form tells you about your rights to privacy regarding your protected health information, and how this information may be used. Video: HIPAA

4. Assignment of Benefits. This form lets you authorize your insurance company to pay your dental benefits directly to your doctor.

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