Office Forms

- ALL OUR FORMS ARE NOW ONLINE - 

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.)

EXISTING PATIENTS

If your child has a checkup (cleaning) appointment, please fill out this form: Health History Update  (Actualización del Historial de Salud)

If your child has a treatment (filling, extraction...) appointment, please fill out this form: Respiratory Illness Screening

NEW PATIENTS

After scheduling your child's first appointment, please fill out these forms: 

New Patient Registration (Formulario de Registración de Paciente)

New Patient Health History (Historial de Salud) 

Additional Specialty/Provider forms:

Authorization to Release Patient Record   (Autorización Para Divulgar registros de Pacientes)

Referral Form

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