510-972-3262

Patient Forms

The 4 patient forms below are required of every new patient. New patients should print the forms, fill them in, and bring them to your first appointment. We will have you sign and date the forms upon arrival. If you do not bring the forms with you, you’ll need to fill out a copy in the waiting room before your appointment.

New Patient Forms

Please contact us for the Patient Registration Form – This form coveres the following:

  • Contact info, health insurance info
  • Financial Policy and Consents
  • Understand our payment policy for services rendered
  • This form describes how your dental information is protected