Patient Forms

(909) 902-9100

If you are a new patient to our office or an existing patient, below contains our patient forms that will need to be filled out before you arrive at our office.

Filling them out will allow us to attend to your medical needs more quickly than completing them on your arrival. Thank you and please call our office if you have any questions at all.

The first visit to our office is designed to get you better acquainted with all we offer as well as introduce you to our Doctor and our caring staff. We encourage questions and do our best to always deliver quality care.


Printable Forms 

Patient Medical History Form

Biopsy Consent Form

Bone Grafting Consent Form

Crown Lengthening Surgery Consent Form

Dental Implant Consent Form

Extraction Consent Form

GA Instructions (English)

General Anesthesia Consent Form

General Anesthesia Information

General Dentistry Consent Form 

Non-Surgical Consent Form

(Pedo) Recommended Treatment Plan

(Pedo) Silver Diamine Fluoride Consent Form

Perio Surgery Consent Form

Regeneration Consent Form

Sedation Consent Form

Sinus Augmentation Consent Form

Soft Tissue Consent Form

What To Expect for Your 1st Pedo Visit


Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.

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