Patients Form

We want our new patient experience to be as pleasant as possible for our patients. One step in the right direction is our new patient’s having the right tools when coming to our office for the first time. Using the links below please download the new patient paperwork and bring it with you to your first appointment. Also, if you have current dental x-rays they are of great help to our clinical staff and will prevent any out of pocket your insurance company may charge you for repeat x-rays. The directions to our office are provided below. Please don’t hesitate to contact us prior to your appointment should you have any questions. We sincerely look forward to having you as a patient at Railroad dental Associates.

Printable Forms

Please take a minute to print and fill out the patient information form before your first appointment:

» Patient Registration Form [PDF]

» Medical History [DOC]

» Financial Policy and Dental Insurance  [DOC]

» HIPAA Notice of Privacy Practices[DOC]

» HIPAA Patient Info Release Form  [DOC]

» RDA HIPAA Notice of Privacy Practices [DOC]

If you’re unable to open PDF files, you can get Adobe Reader® for free.

Click here to contact us or to request an appointment. Most insurance plans accepted. Ask about our Smile Club for those uninsured patients. We are currently a registered office for Smiles for Children. Contact us today!


Directions and Parking

Feel free to call our office at 703-365-0230