New Patients
New Patients
You can save time at your appointment by having the necessary New Patient forms
filled out ahead of time. Please open, print and fill out the following PDF forms.
You can bring them with you to the appointment or fax them to our office at:
909-581-6669.

English

   1. New Patient Information and Medical History Sheet
   2. General Consent Form
   3. Hippa Form
   4. Dental Materials Facts Sheet
   5. Acknowledgement

Spanish

   1. Informacion del Paciente Y Historia de salud
   2. Consento Para Tratamiento Dental General
   3. Notificacion de practicas privadas
   4. Hoja Dental de Hecho de Materiales
   5. Reconocimiento

We accept all major credit cards.  In addition, if you need financial assistance with your bill, you can download and fill out the CareCredit application and fax it back to us. Or click here to apply instantly online.

  

               
 

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