New Patient Forms

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What you should know prior to your first visit

Complete health history form prior to your visit

Prior to your exam, you’ll complete a health history which helps us identify oral and overall health issues we should watch out for. The form is available on this page. While you may be surprised at the thoroughness of the form, we believe it’s important we have all relevant information as part of healthcare team, and it’s an important step in helping us care for you properly.

What you should bring to your first visit:

  1. Dental insurance card, if applicable
  2. Photo ID card
  3. Completed new patient forms
Call our office with questions

 

New Patient Form

We’ll need the information on the form prior to getting started. Please download and complete the form below and bring it to your first visit. If you are not able to complete these forms prior to your first visit, please arrive 30 minutes before your scheduled appointment.

The form is a PDF and requires you have Adobe Reader to open it. (Nearly all computers have this. If you cannot open the form, you can download it here:   Adobe Reader.)

After opening the form, you can place your cursor in the text fields and type your answers. You can also click the appropriate selections to choose Yes/No, etc.

To print the form from your computer:

  • Choose File > Print or click  icon in the toolbar
  • Select a Printer
  • Click Print
  Dental Office

7803 Madison Ave
Building C, Suite 670
Citrus Heights, CA 95610

  916.961.6406

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  Office Hours

Mon-Wed: 8:00AM – 5:00PM
Thur: 9AM-1PM (by appt. only)
Fri-Sun: Closed

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Free Exam

Don’t put off your healthy smile any longer. Schedule your free exam today.

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Patient Reviews

  My life has changed with implant dentistry. I used to have a full denture that would fall out when talking or move around when I was eating. I was limited on what I could eat. It was awful. Now, with my implant retained denture, I can eat whatever I want and not worry about my denture falling out whenever I was talking to someone.   – Jack

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