Robert Lustbader DDS
Robert Lustbader DDS

Patient Required Paperwork

If you would like to save time on the day of your appointment, please print out the following forms and fill in all sections completely.  By bringing them with you before your appointment it will reduce your time in the waiting room leaving you free to relax while waiting to be seen.


Please note that our office policy includes the requirement of having patient medical history form re-done every 2 years.  We encourage our existing patients to print these out and have them completed prior to their appointments as well to save time.



**(Please note, there is no need to bring the actual Privacy Notice with you to the office.  This document is for your reference only)**

Patient Medical History Form
Lustbader 2015 Form Fillable.pdf
Adobe Acrobat document [270.0 KB]
HIPAA Acknowledgement Form
HIPAA Acknowledgement.docx
Microsoft Word document [15.9 KB]
Privacy Notice Page 1
Privacy Notice P.1.docx
Microsoft Word document [17.1 KB]
Privacy Notice Page 2
Privacy Notice P.2.docx
Microsoft Word document [12.8 KB]

Call Us Today to Make an Appointment







Robert Lustbader DDS

425 Robinson Avenue

Newburgh, NY 12550



Office Hours


MON  8am - 6pm

TUE   8am - 5pm

WED  8am - 6pm

THU   8am - 6pm

FRI    8am - 5pm

SAT   8am - 1pm



Outside our regular business hours, please note our emergency care information.


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