Patient Forms

For your convenience, please download the PDF fillable forms and save on desktop, fill and print. On an average it will take at least 15-20 minutes to fill these forms at the office. Please plan on arriving accordingly to your first appointment. Please update us if there are any changes to your health status, insurance and/or contact information.

Para su comodidad, descargue los formularios PDF que se pueden completar y guárdelos en el escritorio, complete todas las secciones e imprima. En promedio, tomará entre 15 y 20 minutos completar estos formularios en la oficina. Por favor, planee llegar en consecuencia a su primera cita. Actualícenos si hay algún cambio en su estado de salud, seguro o información de contacto.

New Patient Forms

Patient Registration Form

English and Spanish

Medical / Dental History

Print in Landscape only

Existing Patient Forms

Recall History

English and Spanish

Consent for Treatment

English – Page 1; Spanish – Page 2

For Information Purposes

Office & Financial Policy

English – Page 1; Spanish – Page 2

Patient Care Instructions

English – Page 1; Spanish – Page 2

What to expect at your first visit:

— Verification of personal information, health history and benefit plan / insurance coverage
— Exam, X-rays, pictures, consultation and simple teeth cleaning (if applicable)
— Topical fluoride (Kids), oral hygiene instructions and patient samples
— Discuss treatment plan and insurance breakdown for payments
— Follow-up treatment / recall visit appointment