We appreciate your time, therefore we put necessary forms available for patients to fill out prior to their dental visit. In order to fill out the New Patient Information form you will need Microsoft Word 2007 and greater. Please fill the form out on your computer, press tab to get to the next highlighted section, once finished filling the form save to your computer and send it via email to firstname.lastname@example.org. Or simply print and bring to your dental appointment. The PDF files are for your information only and do not need to be brought to the office.
- New Patient Form Updated Nov 2016 (PDF Form) – Right Mouse Click to Save Form to Computer. Open with Adobe Reader 7.0+ to fill out form electronically and save/print. The latest Adobe Reader is available here.
- Dental Material Facts Sheet (PDF)
- Health Information Privacy Act (PDF)
Paperwork for Financing
Please click on the link(s) below to open up the application to get approved for financing. Once forms are filled out press accept and submit button and wait for approval.
|CareCredit Dental Financing||CitiHealthCard|
We proudly service patients in the greater San Jose Silicon Valley
San Jose • Cupertino • Sunnyvale • Campbell • Palo Alto • Mountain View • Los Gatos • Saratoga • Evergreen • Berryessa • Milpitas • Fremont