Lily W. Eng, DDS 101 Lafayette Street, 9th Floor, New York, NY 10013 212-842-5300, 212-842-8042
Lily W. Eng, DDS
101 Lafayette Street, 9th Floor, New York, NY 10013
212-842-5300, 212-842-8042
Thank you for selecting our dental healthcare team! To help us meet all your dental needs, please read our office policy of parent / legal guardian carefully, and fill out this form completely in ink. If you have any questions or need assistance, please ask us – we will be happy to help.
*Child must be accompanied by a parent or legal guardian for the first visit, first injection in this office, and irreversible treatment. An authorized adult can accompany the child for all other visits.
** Your child will only be treated when accompanied by a Guardian/Parent or an authorized person listed on this form. Please provide information of individuals who are authorized to accompany the child to dental visits, consent for dental treatment and financial agreements. (Please Note: Authorized Guardian must be 18 years or older)
*Authorized Guardian information will be valid for all visits unless otherwise indicated.
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