Patient Forms

For your convenience the standard forms are available to fill out before you arrive, which will assure faster processing of your paperwork at your appointment. So when you arrive for your appointment all you will have to do is sign and date these forms to validate that they are accurate and up to date. You may supply the information by one of the following five ways:

1. Download the Registration and Health History forms and fill them out in Adobe Acrobat Reader or another compatible software program and email the saved forms to us at DentistryofAlameda@gmail.com 
2. Print and fill out the Registration and Health History forms and send them to us by fax 510-523-4461.
3. Print and fill out the Registration and Health History forms and mail them to us one week before your appointment. (2500 Central Ave, Alameda, CA 94501)
4. Print and fill out the Registration and Health History forms, and bring them with you at the time of your appointment.
5. Or wait until your first appointment and fill out this information at our office.

These forms are important because when combined with the results of your initial clinical examination, we will than be able to access your immediate dental care needs and recommend the best treatment approach.

Be sure to mention everything about your health, even if you don't think it relates to your dental care. If you have had surgery or a major illness, be sure to include this information in this medical history. Many diseases can have significant effects on your mouth and teeth, and research continues to discover ways in which oral health is related to overall health.

Information about medications you are currently taking can be vital to your health, especially in an emergency. When you come to your appointment be sure to bring a current list of medications you are taking to insure an accurate record.

We assure you that all the information you provide us with will remain confidential.

Registration Forms

Health  History Form

Medical History 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.