Patient Forms

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.

Office location:
1145 Second St., Ste G
Brentwood, CA
Phone: 925.634.1230

If you are a new patient to our office, the link contains our new patient bundle with forms that will need to be filled out when you arrive at our office. By filling out your paperwork electronically we can quickly get your information into to our system securely and helps to eliminate errors. Thank you and please call our office if you have any questions.  

Filling out the paperwork online ahead of your appointment helps maximize the time you have in our office. 

New Patient Form Bundle With Insurance

New Patient Form Bundle Without Insurance

Consent for Release of Records from Another Office (PRINT VERSION)

These are the forms we will get back to you at your appointment if you want.  If you are like most and don't want a stack of goverment mandated paperwork when you leave here but think you might want access to what it contains, below are the forms.

HIPAA - Notice Of Privacy Practices Form

Dental Materials Fact Sheet

Here are a couple more handouts that may help answer any questions on treatment you may have had in our office (or another and you prefer our site).

Extraction Post Op

Extraction Post Op (Espanol)

Deep Cleaning Post Op

Implant Placement Post Op

Root Canal Post Op