Call: (831) 662-2900

EXISTING Patient Forms



Part of our strategy for keeping you and your child safe is to minimize our use of pens and paper. Therefore, we are asking that everyone fill out our secure, encrypted online forms BEFORE they arrive for their visit. If you are unable to use our online forms for any reason, please call us and we will provide you with an alternative method. As always, if you have any questions please call us at 831-662-2900.

(Please note, our Google forms are all secure, encrypted and HIPAA compliant.)

All PATIENTS RETURNING FOR A CHECKUP, in addition to the Covid-19 Screening Form, please fill out the following health update form BEFORE your child's visit. 

Health History Update Form

(Actualización del Historial de Salud)


If you just had a checkup and are returning for treatment, please fill out and submit the following Covid-19 screening form the night before your child's visit (we will not be able to see your child if this form has not been filled out.)

Covid-19 Patient Screening Form



Additional Specialty forms:

Authorization to Release Patient Record

(Autorización Para Divulgar registros de Pacientes)

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free

Office Location

  • Aptos
  • 7545 Soquel Drive Suite A
  • Aptos, California
  • 95003
  • Map & Directions
  • Call: (831) 662-2900