Patient Forms

School Forms

If you need forms for school or daycare filled out

  • Write your child's name and date of birth on the form

  • Scan, upload and attach it to an outgoing email

  • Send it to

  • Monitor your email for the completed form, you can expect a response in 5-7 business days

To scan and upload forms with a smartphone


  1. Open a note or create a new note.

  2. Tap , then tap Scan Documents.

  3. Place your document in view of the camera on your device.

  4. If your device is in Auto mode, your document will be automatically scanned. If you need to manually capture a scan, tap  or one of the Volume buttons.

  5. Drag the corners to adjust the scan to fit the page, then tap Keep Scan.

  6. You can add additional scans to the document or tap Save when you're done.

  7. From here, you can attach the document to an email.


  1. Open the Google Drive app .

  2. In the bottom right, tap Add .

  3. Tap Scan .

  4. Take a photo of the document you'd like to scan.

    • Adjust scan area: Tap Crop .

    • Take photo again: Tap Re-scan current page .

    • Scan another page: Tap Add .

  5. To save the finished document, tap Done.

  6. From here, you can attach the document to an email

Find us:
  • Facebook App Icon
  • YouTube Classic
  • Twitter App Icon
  • Instagram App Icon
  • Google+ App Icon

Pediatric Dental Team

Providing pediatric dentistry, children's dentistry, orthodontics, and braces, 

to the Philadelphia and South Philadelphia community
2010 South Juniper Street

Philadelphia, PA 19148