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For patients

Patient forms

Please take a minute to fill out the patient information form before your first appointment. It saves time at check-in and gives the doctor what they need to care for you.

Download patient forms View in browser (opens in a new tab)

PDF · 3 pages · 685 KB. Print, fill out, and bring to your visit.

Two young women cheek to cheek with bright smiles

Before your first visit

Download the forms, print them, fill them out at home, and bring them with you. If you’re unable to open PDF files, you can get Adobe Acrobat Reader (opens in a new tab) for free.

What’s in the packet

  1. Patient information Your contact details, the person responsible for the account, and your dental insurance.
  2. Medical and dental history Medications, allergies, health conditions and your dental history, so the doctor can treat you safely.
  3. HIPAA consent How we protect your health information. Please sign and date it.
Download all 3 forms Print, fill out, and bring to your visit.

The forms ask for personal and insurance details, so please bring the completed pages with you rather than emailing them.

Please bring these to your first appointment:

  • Your completed patient information form
  • Your insurance card

Curious about the rest of your visit? Read what to expect at your first appointment, review our payment options, or browse the dental FAQs.

Ready for your next visit?

Call our north Fresno office or send an appointment request, and our front desk will find a time that works for you.

Request appointment (559) 431-5544
Monday to Thursday
7 AM to 7 PM
Friday
7 AM to 1 PM
Saturday and Sunday
Closed