Patient Forms

Patient Forms

Please take a minute to print and fill out the patient information form before your first appointment:

Medical History – Under 18  Medical History – Adult  Covid 19 Questionnarie Hipaa compliance form Biophosphonate IC Informed Consent for an Impacted Tooth or Teeth Informed Consent TADs Suppplemental Informed Consent COVID-19 AAO Suppplemental Health Questionnaire Informed Consent For The Orthodontic Patient

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Locations

10055 Miller Avenue, Suite 103, Cupertino, CA 95014

[email protected]

  • MON: 9:00 am - 5:00 pm
  • WED: 9:00 am - 5:00 pm
  • SAT: 9:00 am - 2:00 pm
  • We are open one Saturday a month.

826 Altos Oaks Drive, #3, Los Altos, CA 94024

[email protected]

  • TUE: 9:00 am - 5:00 pm
  • THU: 8:00 am - 4:00 pm
  • SAT: 9:00 am - 2:00 pm
  • We are open one Saturday a month.
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