Patient Forms

As part of your health care, Dr. Butler maintains medical records, some of which describe your health history, symptoms, exams, test results, etc. for the purposes of planning your care and treatment. All of this information is protected and confidential. The forms below are necessary to inform you of our privacy practices, to obtain your health information so we can provide our best care possible. Please fill these out prior to your first appointment. You may bring them with you, fax or email them.

Carroll R. Butler, DDS PA
321 West Water Street
Kerrville, TX 78028

830-792-3529 (fax)

New Patients Forms:

Patient Privacy Consent Form
Patient Privacy Notice
Receipt of Patient Privacy Notice
Confidential Questionnaire
Medical History
Dental History
Financial Policy