Manik R. Khisti, DMD, PLLC

Family General Dentistry in Chester, VA

Manik R. Khisti, DMD, PLLC
Family General Dentistry in Chester, VA

Tel: (804) 717-5400

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    • Khisti Dental Center at Chester
    • Khisti Dental Center at Glen Allen
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    • Preventive Services
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Forms

New Patients: 

New Patient Paperwork and a COVID-19 Consent Form are available for you to download and bring with you for your first visit.

New Patient Forms

We have provided below our Notice of Privacy Practices for your review before signing the HIPAA page in your new patient paperwork. There is no need to print this out unless you would like it for your own records.

HIPAA Notice of Privacy Practices

Adult patients can expect a comprehensive set of x-rays and a thorough exam at their first visit.  We do try to complete your cleaning during this same visit, unless additional hygiene services are needed.  It is generally not necessary to bring your old x-rays or chart, unless you have extensive treatment that is in-progress.  Children will generally receive age-appropriate x-rays, a cleaning, and a fluoride treatment.

 

Existing Patients:

A blank Medical History Update Form and a COVID-19 Consent Form are available for you to download and bring with you for your upcoming appointment.  If your medical history is extensive and you would prefer for us to have your form auto-populated and ready for you to sign at your arrival, we are more than happy to do that for you.  Forms are available to download here:

Medical History Update

COVID Consent

HIPAA consent (see below)

*A HIPAA update is only needed if: 1) the patient has turned 18 since the last visit, or 2) the patient would like to change who we are able to share their information with. Divorce, marriage, death in the family, etc, are examples of reasons someone may want to update their HIPAA Consent. Our Notice of Privacy Practices is located above, in the new patient section, if you would like a refresher.

 

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