PATIENT FORMS
Patient Forms
To begin your journey to a healthier smile, we ask you to complete a registration form as well as records release so we can better understand you and your dental history.
Patient Registration
Register with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
Records Release
Due to the sensitive nature of record releases, please contact our office to have a release of records emailed via our electronic system.
Get in Touch
SCHEDULE YOUR APPOINTMENT
Don’t let failing and missing teeth keep you from feeling confident or from doing the things you love. Call us today at +1 209-632-3101 to invest into your health, your life, and your future.
