{"id":4381086,"date":"2020-05-20T15:54:15","date_gmt":"2020-05-20T15:54:15","guid":{"rendered":"http:\/\/centralparkdentistry.com\/newsite\/?page_id=4381086"},"modified":"2026-03-09T13:51:36","modified_gmt":"2026-03-09T13:51:36","slug":"patient-information","status":"publish","type":"page","link":"https:\/\/centralparkdentistry.com\/site\/patient-information\/","title":{"rendered":"Patient Information"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; fullwidth=&#8221;on&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_fullwidth_header module_class=&#8221;dct-header-title&#8221; _builder_version=&#8221;4.27.6&#8243; title_font=&#8221;||||||||&#8221; content_font=&#8221;||||||||&#8221; content_text_align=&#8221;center&#8221; background_color=&#8221;rgba(0,0,0,0.71)&#8221; background_image=&#8221;https:\/\/centralparkdentistry.com\/site\/wp-content\/uploads\/2026\/02\/CPD-235crop-scaled.jpg&#8221; background_blend=&#8221;overlay&#8221; custom_padding=&#8221;200px||363px|||&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;50px|||&#8221; custom_padding_last_edited=&#8221;on|phone&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; button_one_text_size__hover_enabled=&#8221;off&#8221; button_two_text_size__hover_enabled=&#8221;off&#8221; button_one_text_color__hover_enabled=&#8221;off&#8221; button_two_text_color__hover_enabled=&#8221;off&#8221; button_one_border_width__hover_enabled=&#8221;off&#8221; button_two_border_width__hover_enabled=&#8221;off&#8221; button_one_border_color__hover_enabled=&#8221;off&#8221; button_two_border_color__hover_enabled=&#8221;off&#8221; button_one_border_radius__hover_enabled=&#8221;off&#8221; button_two_border_radius__hover_enabled=&#8221;off&#8221; button_one_letter_spacing__hover_enabled=&#8221;off&#8221; button_two_letter_spacing__hover_enabled=&#8221;off&#8221; button_one_bg_color__hover_enabled=&#8221;off&#8221; button_two_bg_color__hover_enabled=&#8221;off&#8221; title_text=&#8221;CPD-235crop&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<h1>Patient Information<\/h1>\n<p>[\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;4px|0px|0|0px|false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row column_structure=&#8221;1_2,1_2&#8243; make_equal=&#8221;on&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;63px|0px|13px|0px|false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text module_class=&#8221;dct_h5_span&#8221; _builder_version=&#8221;4.16&#8243; text_font=&#8221;||||||||&#8221; text_line_height=&#8221;2em&#8221; header_font=&#8221;||||||||&#8221; header_3_font=&#8221;|||on|||||&#8221; header_3_line_height=&#8221;1.8em&#8221; header_4_font=&#8221;||||||||&#8221; header_4_text_align=&#8221;justify&#8221; header_4_line_height=&#8221;1.6em&#8221; header_5_font=&#8221;|||on|||||&#8221; header_5_line_height=&#8221;2em&#8221; text_orientation=&#8221;justified&#8221; custom_margin=&#8221;-13px|||&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<div>\n<h4>Important forms and information for new and existing Central Park Dentistry Patients<\/h4>\n<p>&nbsp;<\/p>\n<p>IMPORTANT UPDATE:\u00a0 We have added a new COVID consent form for all new and <em>current<\/em> Central Park Dentistry patients that you will need to complete prior to your visit with us.\u00a0<\/p>\n<p>Your first visit with us will of course be a little different than your subsequent visits.\u00a0 This is of course because we need to gather some important information about you prior to getting started.\u00a0 The main thing to be aware of is that you&#8217;ll need to complete some forms which we&#8217;ve included on this page for you to download and print out and complete prior to your first visit.\u00a0 In the future our office will allow you to do all of this safely and securely online, but for now please print and bring them with you.<\/p>\n<p>Don&#8217;t have a printer or way to complete these ahead of your visit?\u00a0 No problem, just arrive early for your first visit and our staff will be happy to provide you with these forms at that time.\u00a0\u00a0<\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_button button_url=&#8221;https:\/\/rwl.io\/3edob8R&#8221; url_new_window=&#8221;on&#8221; button_text=&#8221;1. 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Financial Agreement Form&#8221; admin_label=&#8221;Financial Notice Form&#8221; module_class=&#8221;dct_btn&#8221; _builder_version=&#8221;4.16&#8243; custom_button=&#8221;on&#8221; button_text_size=&#8221;17px&#8221; button_text_color=&#8221;#ffffff&#8221; button_font=&#8221;|||on|||||&#8221; button_icon=&#8221;&#x24;||divi||400&#8243; global_colors_info=&#8221;{}&#8221;][\/et_pb_button][et_pb_button button_url=&#8221;https:\/\/rwl.io\/2LPNVfk&#8221; url_new_window=&#8221;on&#8221; button_text=&#8221;4. Insurance Information Form&#8221; admin_label=&#8221;COVID Consent Form&#8221; module_class=&#8221;dct_btn&#8221; _builder_version=&#8221;4.27.0&#8243; custom_button=&#8221;on&#8221; button_text_size=&#8221;17px&#8221; button_text_color=&#8221;#ffffff&#8221; button_font=&#8221;|||on|||||&#8221; button_icon=&#8221;&#x24;||divi||400&#8243; global_colors_info=&#8221;{}&#8221;][\/et_pb_button][et_pb_text _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3>PRINTABLE FORMS (OFFLINE)<\/h3>\n<p>1.\u00a0 <a href=\"https:\/\/centralparkdentistry.com\/site\/wp-content\/uploads\/2021\/08\/NEW-PATIENT-FORM-pg-1-2021.pdf\" target=\"_blank\" rel=\"noopener\">Patient Information Form<\/a><\/p>\n<p>2.\u00a0 <a href=\"https:\/\/centralparkdentistry.com\/site\/wp-content\/uploads\/2021\/08\/Medical_History_Form_16_final.pdf\" target=\"_blank\" rel=\"noopener\">Health History Form<\/a><\/p>\n<p>3.\u00a0 <a href=\"https:\/\/centralparkdentistry.com\/site\/wp-content\/uploads\/2021\/08\/FINANCIAL-FORM-2021.pdf\" target=\"_blank\" rel=\"noopener\">Financial Agreement Form<\/a><\/p>\n<p>4.\u00a0 <a href=\"https:\/\/centralparkdentistry.com\/site\/wp-content\/uploads\/2021\/08\/INSURANCE-INFORMATION2020.pdf\" target=\"_blank\" rel=\"noopener\">Insurance Information Form<\/a><a href=\"http:\/\/centralparkdentistry.com\/newsite\/wp-content\/uploads\/2020\/06\/covid-consent-final.pdf\"><\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; 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custom_margin=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<div class=\"dct-title clearfix\">\n<h3 class=\"hadding\">Our Location<\/h3>\n<p>23 N Federal Ave, Mason City, IA<\/p>\n<\/div>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; fullwidth=&#8221;on&#8221; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_fullwidth_code _builder_version=&#8221;4.16&#8243; text_orientation=&#8221;center&#8221; global_colors_info=&#8221;{}&#8221;]<iframe loading=\"lazy\" src=\"https:\/\/www.google.com\/maps\/embed?pb=!1m18!1m12!1m3!1d2910.7118934574783!2d-93.2028508851383!3d43.15257889267664!2m3!1f0!2f0!3f0!3m2!1i1024!2i768!4f13.1!3m3!1m2!1s0x87f107144d403a55%3A0x22cf6eb73e88cbf1!2s23%20N%20Federal%20Ave%2C%20Mason%20City%2C%20IA%2050401!5e0!3m2!1sen!2sus!4v1590035098261!5m2!1sen!2sus\" width=\"100%\" height=\"400\" frameborder=\"0\" style=\"border:0;\" allowfullscreen=\"\" aria-hidden=\"false\" tabindex=\"0\"><\/iframe><!-- [et_pb_line_break_holder] -->[\/et_pb_fullwidth_code][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; 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module_class=&#8221;dct_divider&#8221; _builder_version=&#8221;4.16&#8243; max_width=&#8221;15%&#8221; module_alignment=&#8221;left&#8221; custom_margin=&#8221;-20px|||&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_divider][et_pb_text _builder_version=&#8221;4.16&#8243; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;#808080&#8243; text_font_size=&#8221;13px&#8221; custom_margin=&#8221;-30px||&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>Please follow us on Facebook for the latest updates!<\/p>\n<p>[\/et_pb_text][et_pb_social_media_follow _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_social_media_follow_network social_network=&#8221;facebook&#8221; url=&#8221;https:\/\/www.facebook.com\/CentralParkDentistry\/&#8221; _builder_version=&#8221;4.16&#8243; background_color=&#8221;#3b5998&#8243; global_colors_info=&#8221;{}&#8221; follow_button=&#8221;off&#8221; url_new_window=&#8221;on&#8221;]facebook[\/et_pb_social_media_follow_network][\/et_pb_social_media_follow][et_pb_text _builder_version=&#8221;4.17.4&#8243; text_text_color=&#8221;#ffffff&#8221; background_layout=&#8221;dark&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3><strong>OFFICE HOURS<\/strong><\/h3>\n<ul>\n<li>MON:\u00a0 \u00a08:00 am \u2013 5:00 pm<\/li>\n<li>TUE:\u00a0 \u00a0 8:00 am \u2013 5:00 pm<\/li>\n<li>WED:\u00a0 \u00a08:00 am \u2013 5:00 pm<\/li>\n<li>THU:\u00a0 \u00a08:00 am \u2013 5:00 pm<\/li>\n<li>FRI:\u00a0 \u00a0 8:00 am \u2013 1:00 pm<\/li>\n<\/ul>\n<p>[\/et_pb_text][et_pb_image src=&#8221;https:\/\/centralparkdentistry.com\/site\/wp-content\/uploads\/2021\/07\/delta-dental-logo-300&#215;37.jpg&#8221; alt=&#8221;We accept Delta Dental&#8221; title_text=&#8221;delta dental logo&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_image][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; admin_label=&#8221;Dental Services Column&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text module_class=&#8221;dct-footer-title&#8221; _builder_version=&#8221;4.16&#8243; text_font=&#8221;|700||on|||||&#8221; text_text_color=&#8221;#ffffff&#8221; text_font_size=&#8221;20px&#8221; header_font=&#8221;||||||||&#8221; header_text_color=&#8221;#000000&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>Dental Services<\/p>\n<p>[\/et_pb_text][et_pb_divider divider_weight=&#8221;3px&#8221; module_class=&#8221;dct_divider&#8221; _builder_version=&#8221;4.16&#8243; max_width=&#8221;15%&#8221; module_alignment=&#8221;left&#8221; custom_margin=&#8221;-20px|||&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_divider][et_pb_text _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;-30px||&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<ul class=\"list-border list theme-colored angle-double-right\">\n<li><a href=\"#\">Preventative Care<\/a><\/li>\n<li><a href=\"#\">Invisalign<\/a><\/li>\n<li><a href=\"#\">Dental Surgery<\/a><\/li>\n<li><a href=\"#\">Children\u2019s Dental Care<\/a><\/li>\n<li><a href=\"#\">Implants &amp; Dentures<\/a><\/li>\n<li><a href=\"#\">Full Service Dental Care<\/a><\/li>\n<\/ul>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; admin_label=&#8221;Patient Forms Column&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text module_class=&#8221;dct-footer-title&#8221; _builder_version=&#8221;4.16&#8243; text_font=&#8221;|700||on|||||&#8221; text_text_color=&#8221;#ffffff&#8221; text_font_size=&#8221;20px&#8221; header_font=&#8221;||||||||&#8221; header_text_color=&#8221;#000000&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>Patient Forms<\/p>\n<p>[\/et_pb_text][et_pb_divider divider_weight=&#8221;3px&#8221; module_class=&#8221;dct_divider&#8221; _builder_version=&#8221;4.16&#8243; max_width=&#8221;15%&#8221; module_alignment=&#8221;left&#8221; custom_margin=&#8221;-20px|||&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_divider][et_pb_text _builder_version=&#8221;4.27.0&#8243; custom_margin=&#8221;-30px||&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<ul class=\"list-border list theme-colored angle-double-right\">\n<li><a href=\"https:\/\/rwl.io\/3edob8R\" target=\"_blank\" rel=\"noopener noreferrer\">Patient Information<\/a><\/li>\n<li><a href=\"https:\/\/rwl.io\/36jZ29t\" target=\"_blank\" rel=\"noopener noreferrer\" title=\"Health History\">Health History<\/a><\/li>\n<li><a href=\"https:\/\/rwl.io\/3cVfIqC\" target=\"_blank\" rel=\"noopener noreferrer\">Financial Agreement<\/a><\/li>\n<li><a href=\"https:\/\/rwl.io\/2LPNVfk\" target=\"_blank\" rel=\"noopener noreferrer\">Insurance Information<\/a><\/li>\n<li><a href=\"https:\/\/forms.patientconnect365.com\/3847\/form\/21123531\" target=\"_blank\" rel=\"noopener noreferrer\">Records Release<\/a><\/li>\n<\/ul>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; module_class=&#8221;dct_timetable&#8221; admin_label=&#8221;Quick Connect Column&#8221; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text module_class=&#8221;dct-footer-title&#8221; _builder_version=&#8221;4.16&#8243; text_font=&#8221;|700||on|||||&#8221; text_text_color=&#8221;#ffffff&#8221; text_font_size=&#8221;20px&#8221; header_font=&#8221;||||||||&#8221; header_text_color=&#8221;#000000&#8243; global_colors_info=&#8221;{}&#8221; text_font_size__hover_enabled=&#8221;on&#8221; text_font_size__hover=&#8221;20px&#8221;]<\/p>\n<p>Quick Contact<\/p>\n<p>[\/et_pb_text][et_pb_divider divider_weight=&#8221;3px&#8221; module_class=&#8221;dct_divider&#8221; _builder_version=&#8221;4.16&#8243; max_width=&#8221;15%&#8221; module_alignment=&#8221;left&#8221; custom_margin=&#8221;-20px|||&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_divider][et_pb_text _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;-25px||&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<ul class=\"list list-border\">\n<li><span>641-423-4225<\/span><\/li>\n<li><a href=\"http:\/\/centralparkdentistry.com\/newsite\/contact-us-v1\/\">E-Mail Us<\/a><\/li>\n<li>23 N Federal Ave<\/li>\n<li>Mason City, IA<a href=\"#\" class=\"lineheight-20\"><\/a><\/li>\n<\/ul>\n<p>[\/et_pb_text][et_pb_text module_class=&#8221;dct-footer-title&#8221; _builder_version=&#8221;4.16&#8243; text_font=&#8221;|700||on|||||&#8221; text_text_color=&#8221;#ffffff&#8221; text_font_size=&#8221;20px&#8221; header_font=&#8221;||||||||&#8221; header_text_color=&#8221;#000000&#8243; global_colors_info=&#8221;{}&#8221; text_font_size__hover_enabled=&#8221;on&#8221; text_font_size__hover=&#8221;20px&#8221;]<\/p>\n<p>Notices<\/p>\n<p>[\/et_pb_text][et_pb_divider divider_weight=&#8221;3px&#8221; module_class=&#8221;dct_divider&#8221; _builder_version=&#8221;4.16&#8243; max_width=&#8221;15%&#8221; module_alignment=&#8221;left&#8221; custom_margin=&#8221;-20px|||&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_divider][et_pb_text _builder_version=&#8221;4.16&#8243; custom_margin=&#8221;-25px||&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<ul class=\"list list-border\">\n<li>\n<a href=\"https:\/\/centralparkdentistry.com\/site\/locations\/non-discrimination-notice\/\">Nondiscrimination<\/a><\/li>\n<li><a href=\"https:\/\/centralparkdentistry.com\/site\/locations\/language-assistance\/\">Language Assistance<\/a><\/li>\n<li><a href=\"https:\/\/centralparkdentistry.com\/site\/new-patients-2\/privacy-practices\/\">Privacy Practices<\/a><\/li>\n<\/ul>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Patient Information Important forms and information for new and existing Central Park Dentistry Patients &nbsp; IMPORTANT UPDATE:\u00a0 We have added a new COVID consent form for all new and current Central Park Dentistry patients that you will need to complete prior to your visit with us.\u00a0 Your first visit with us will of course be a little different than your subsequent visits.\u00a0 This is of course because we need to gather some important information about you prior to getting started.\u00a0 The main thing to be aware of is that you&#8217;ll need to complete some forms which we&#8217;ve included on this page for you to download and print out and complete prior to your first visit.\u00a0 In the future our office will allow you to do all of this safely and securely online, but for now please print and bring them with you. Don&#8217;t have a printer or way to complete these ahead of your visit?\u00a0 No problem, just arrive early for your first visit and our staff will be happy to provide you with these forms at that time.\u00a0\u00a0 &nbsp; PRINTABLE FORMS (OFFLINE) 1.\u00a0 Patient Information Form 2.\u00a0 Health History Form 3.\u00a0 Financial Agreement Form 4.\u00a0 Insurance Information Form Our [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","ngg_post_thumbnail":0,"footnotes":""},"class_list":["post-4381086","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Patient Information - Central Park Dentistry of Mason City, Iowa<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/centralparkdentistry.com\/site\/patient-information\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Patient Information - Central Park Dentistry of Mason City, Iowa\" \/>\n<meta property=\"og:description\" content=\"Patient Information Important forms and information for new and existing Central Park Dentistry Patients &nbsp; IMPORTANT UPDATE:\u00a0 We have added a new COVID consent form for all new and current Central Park Dentistry patients that you will need to complete prior to your visit with us.\u00a0 Your first visit with us will of course be a little different than your subsequent visits.\u00a0 This is of course because we need to gather some important information about you prior to getting started.\u00a0 The main thing to be aware of is that you&#039;ll need to complete some forms which we&#039;ve included on this page for you to download and print out and complete prior to your first visit.\u00a0 In the future our office will allow you to do all of this safely and securely online, but for now please print and bring them with you. 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