Patient Forms

In order to provide you with the very best dental care, and to adhere to California Law we ask that you complete these necessary forms. From time to time, we may need you to update your information. 

For your ease, you may download these necessary forms. The Patient Registration form and Medical/Dental History form may be completed on the computer and then printed or printed and completed by hand at your leisure.

The HIPAA form may be printed, read and kept or just read online.  We will however, require you to sign an acknowledgement that you received a copy of this HIPAA information from our office. 

Please bring all completed and signed forms with you to your initial visit. If you have been asked by our Administrative Team to complete these forms because  an updated is necessary, please complete these forms and bring them with you to your next appointment. 

(If you need Acrobat Reader, click here.) 

• Patient Registration & Medical History
• HIPAA Notice of Privacy Practice (English)
• HIPAA Notice of Privacy Practice (Spanish)
• Treatment Consent
• Authorization Form for Use or Disclosure of Patient Information English (optional)
• Authorization Form for Use or Disclosure of Patient Information Spanish (optional)