Patient Forms

Health History & Procedure Documentation

Welcome New & Returning Patients

Thank you for entrusting Luxe Anesthesia with your dental sedation and anesthesia needs. Here we’ve compiled a list of health forms and important procedure information, available for download at your convenience.

Please return health history and informed consent forms prior to your scheduled appointment, either online through our secure portal, or by mail to: 

Luxe Anesthesia
PO Box 932
Carrboro, NC 27510

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Cardiovascular Clearance

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History & Physical Form

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Medical Clearance

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Pediatric Anesthesia Overview

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Post-Anesthesia Instructions

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Pre-Anesthesia Instructions

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Informed Consent for Anesthesia

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Pediatric Health History

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Adult Health History

Please return health history and informed consent forms prior to your scheduled appointment, either online through our secure portal, or by mail to: 

Luxe Anesthesia
PO Box 932
Carrboro, NC 27510