Patient Forms

Thank you for your interest in our office! We are accepting new patients! Please feel free to give us a call at 415-386-0790 and our front desk team will gladly assist you.  

New Patients

After a warm greeting, our front desk team will go over your insurance information, and gladly answer any questions you might have about your insurance. After reviewing your insurance information, we will update your medical history. With your medical information updated, our assistants will seat you and possibly take a few x-rays. After the doctor reviews your medical information, he or she will go over your x-rays and/or any recommended potential treatment. Once your cleaning and exam is completed, our front desk will help you check-out and possibly schedule your next appointment! For new patients, kindly fill our the forms below so that our team can seat you as soon as possible!

New Patient Registration Form [PDF]

Medical and Dental History Form [PDF

Notice of Privacy Practice [PDF]

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Emergency Patients

Should a dental emergency occur, we will make every effort to see and care for you as soon as possible.  After hour emergency service can be arranged by calling the emergency contact number provided on the outgoing message of the main line.  For patients with an emergency, our dental assistant will usually take some x-rays to ensure a better diagnosis from the doctor. After reviewing your x-rays, the doctor will recommend the best course of action. With the doctor's treatment plan, our front desk team will present the estimate for the copay.