HoHoKus Perio

Special COVID-19 Patient Screening Mail-in Form:

Click here to print, fill-out and send via regular mail this form, whose receipt by the office is required prior to your appointment. DO NOT EMAIL THIS FORM, AS THAT IS A VIOLATION OF HIPAA REGULATIONS.

Regular Forms:

Please click on the following links to download/complete our forms prior to your visit.

These forms allow you two options to complete: 1) fill-out the information electronically and print, or 2) print and fill-out by hand:

• Patient Registration and Health History Form
• HIPPA Acknowledgment and Consent Form
• Patient Insurance Information Form

Insurance:

Please contact our office at 201-652-0080 for the latest list of insurance plans in which we participate. Please note that we submit your claims even if we do not participate in your plan.