New Patients

New Patient Forms

For your convenience, we made our New Patient Forms available to you in pdf format. We will ask you to print them, fill them out and bring them with you to your appointment.

  • Basic information about you
  • Medical History
    We need to know about any medical issues, allergies or medications you may be taking.
  • Smile Evaluation Form
    This is you “wish list”. We care about our patients, that’s why we would like to know what is important for you. This way we can customize our treatment approach and set priorities according to your best interest.
  • Cancer Screening Form
    In addition to basic visual screening we offer VisiLite screening test. This helps us to provide the best care possible to our patients.
  • Dental Material Fact Sheet
    This paper gives some information about fillings we are using in Dental Practice. The information in this paper approved by Dental Board of California. By law, we have to provide this information to our patients. On the day of you initial visit we will give you a paper to sign testifying that you received this form.
  • Notice of Privacy Practices
    This is another form our new patients have to read and sign for.
  • Dental Plan Info
    This form will ask you about Dental Insurance and describe payment options we offer in the office.

You will need Adobe Reader to see and print these forms.
Please feel free to call us with any questions.