Patient Forms

Thank you for choosing our office to improve and maintain your dental health.
Below are several forms that may be helpful to you as a patient at Azar and Walsh. The forms are provided in PDF format, and you will need the free Adobe Acrobat Reader to view them.
If you have any questions about these forms, we invite you to call our Patient Representative at (570)585-7111. Please take a few moments to print out and answer the questions on the following pages. The information provided is necessary and will help us serve you better.

Downloadable Patient Forms
Patient Registration


301 W. Grove Street, Suite 2e Clarks Summit, PA 18411


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