Patient Forms

The attached documents are PDF and should be "Fill & Sign" through a Adobe Reader system (which is FREE to download HERE). If you are having problems you can print and scan or fax back to us. You may also chose the ONLINE fillable forms below. 

You may email or fax us the paperwork at anytime if you would like at: [email protected] Fax: 408-926-1422

**ALL PAPERWORK PAGES ARE AVAILABLE UPON REQUEST, FOR ELECTRONIC SIGNATURES, LET US KNOW IF YOU ARE HAVING TROUBLES**

General New Patient Paperwork: | PDF | ONLINE |

Annual Medical Update Patient Paperwork: | PDF | ONLINE |

If you are coming to our office as a Special Management or as a Sedation patient we will in addition need these forms filled out as well. We are aware that some of the information may seem the same as the general paperwork but these are requested forms from our Anesthesiologist.

Sedation Paperwork

• Anesthesia General Paperwork
• Anesthesia Health History Form

Teledentistry Form

• Teledentistry Consent form

Treatment Consent Forms

• Filling Consent
• Crown/Bridge Consent
• Extraction Consent
• Root Canal Consent
• Non-Surgical Periodontal (Root Planning) Consent

** ALL REQUIRED PAGES ARE AVAILABLE FOR ELECTRONIC SIGNATURES PER REQUEST IF YOU ARE HAVING COMPUTER/ PRINTER TROUBLES**