Patient Forms

A Secure And Simple Way To Exchange Information

Thank you for filling out the forms before your visit. Its saves you time and helps us keep on schedule. Please fill out three forms; Patient registration, Medial history, and the HIPPA form.

There are two options.

  1. Online with the Yosi App (click the link in the section below).
  2. Download paper forms to fill out and bring to your scheduled appointment.

Secure Online Patient Registration And Medical History

For Your Desktop Browser

Download The Yosi Mobile App For Apple & Android Devices

A more convenient, ON-THE-GO Experience

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PDF Forms for Download & Printing

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Patient Registration Form

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Medical History Form

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HIPAA Privacy Consent Form

If you’re unable to open these files, you probably need to download the free Adobe Reader program, click here to download or click on the Adobe Reader icon

Ready to Schedule Your Appointment?

* All indicated fields must be completed. Please include non-medical questions and correspondence only.

Gallery57Dental

24 West 57th Street Ste. 701 New York, N.Y. 10019

Office Hours

Monday - Friday: 8am - 5pm

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