Patient Forms

All of our patient forms are available to fill out online. If you are unable to complete your intake forms online ahead of time, please arrive to your initial appointment 20 minutes early to fill out paper forms in office. 

Click on the links below to complete the forms:

Patient Information

Office Policies

Medical History 

Dental History 

Insurance Information (if utilizing insurance)

If you would like to share your protected Health Information (such as treatment plans, billing information, or scheduled appointments) with a third party, please also complete this Record Release form:

Records Release Form




Notice of Privacy Practices (for reference only, no need to print)

 

 

If you prefer to print and fill out your forms by hand, please follow the links below to open PDF versions of our intake forms:

New Patient Paperwork

Office Policies




This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.


I cannot say enough about the staff at Niwot dental! They have made going to the dentist a great experience for me AND my children! Not only has he taken great care of my dental health he also did an incredible job with some cosmetic work, a task I was incredibly scared to do considering the horror stories out there. My teeth look and feel great!
A

Amy R.
Best dental experience of my 75 years. 2 hrs in the chair, great block, no pain, no mouth bruising. Great Hands Dr Saeks.
P

Paul H.
Our family, including our 2 young boys, use Niwot Dental for dental care. Dr. Saeks and his staff have provided excellent dental services to our family and we have had nothing but great experiences with them. I just recommend Niwot Dental to a new neighbor who moved into our neighborhood and they received excellent care and I would recommend Niwot Dental to anyone looking for dental care.
J

Jeff C.
My husband, son, and myself have been seeing Dr. Saeks for the past 8 years. Everyone in the office is so professional and nice. Dr. Saeks has done everything from replacing a bridge, doing a crown, and filling cavities. He makes us feel comfortable and relaxed along with providing excellent dental care. I recommend Niwot Dental for all your dental needs! (We even drive from South Denver just to see him)
J

Jackie T.
Could not be happier with Dr. Saeks. He and his staff are really great. I felt completely at ease with him and he corrected some work from a different terrible dentist. My teeth feel so much better and I am happy to have a dentist that I'm comfortable with, it makes it so much easier to schedule that next appointment!
S

Sheena E.
I am a relatively new patient at Niwot Dental, but I cannot recommend this exceptional team highly enough! I am so glad that I chose to switch to their office. Kim's positive first impression is contagious and she is incredibly warm and helpful - even helping me fit in a cleaning and filling around dates of changing insurance. I've seen Jennifer (hygienist) and Karen (dental assist.) who have both been very thorough and friendly, and Dr. Saeks himself, also wonderful, and who just gave me the quickest and most painless filling I've ever had.
A

Allison D.
Excellent dental care. Superb, gentle, quality care in a modern, comfortable office. Also love the option for nitrous oxide if I want it - makes me more comfortable. Great dentist and staff!
B

Benjamin B.
Ready for your first appointment?