Notice to New Patients

To cut down the paperwork processing time, please print, fill out, and bring the new patient forms to the office on your first visit.

New Patient Forms

* (These forms are in Adobe's PDF format. To download Acrobat Reader software, click here and follow the instructions.)

Denti-Cal, PPO, or Indemnity Plan      [Download all forms at once: Part 1 (2.27 Mb), Part 2 (682 Kb)]

• HIPAA - Privacy Act (1.03 Mb)

  • Acknowledgement of Receipt (175 Kb)

  • Authorization of Disclosure (368 Kb) (Sign this form if you would like us to disclose your health information to other parties/family members beside yourself)

• Patient Information (596 Kb) [ Informacion Sobre El Paciente (294 Kb)]

• Informed Consent (682 Kb) [ Consentimiento Informado (713 Kb)]

• Evaluation (153 Kb)

HMO Plan      [Download all forms at once: Part 1 (2.62 Mb), Part 2 (682 Kb)]

• HIPAA - Privacy Act (1.03 Mb)

  • Acknowledgement of Receipt (175 Kb)

  • Authorization of Disclosure (368 Kb) (Sign this form if you would like us to disclose your health information to other parties/family members beside yourself)

• Patient Information (596 Kb) [ Informacion Sobre El Paciente (294 Kb)]

• Informed Consent (682 Kb) [ Consentimiento Informado (713 Kb)]

• To Our Patient's Policy (293 Kb) [ A Nuestros Pacientes (268 Kb)]

• Evaluation (153 Kb)