New Patient Paperwork

Want to save time on your first visit? Print your new patient forms and bring them on your first visit :)

English

• Patient Information and Health History form
• Cancellation form
• Smile Evaluation
• Notice of Privacy Act

Spanish

• Informacion General
• Historia de Salud parte 1
• Parte 2
• Politica de Oficina
• Reconocimiento de Acto de Privacidad

We can verify your dental coverage prior to your visit. Just email us the following information.

Click here to email

• Name of the Patient
• Patient's date of birth
• Subscriber name
• Subscriber date of birth
• Insurance Name and provider's toll free number