Patient Registration

Please download these forms and fill them out at your convenience. Bring the completed forms to your office visit.

Please assist us by providing the following information at the time of your consultation:

• Any X-rays taken by a previous dentist — if not more than 6-months old, if applicable.
• A list of medication you are presently taking.
• Your completed New Patient Registration Form
• Your completed Confidential Medical & Dental History Form

IMPORTANT:  Please alert the office if you have a medical condition that may be of concern prior to treatment (i.e., diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc) or if you are currently taking any medication (i.e., heart medications, aspirin, anticoagulant therapy, etc)

For assistance, please call our Eureka office: Eureka Office Phone Number 707-443-3005