Dental Hygiene Clinic
Forms
Please print, fill out and bring the below listed
forms to your 1st appointment:
New Patients (English)
- Welcome and Consent Form
- Medical and Dental History
- HIPAA Consent
- FO24 - Authorization for the Release of Dental Record
- Medical Consultation Form
Nuevos Pacientes (Español)
- Forma de Bienvenida y Consentimiento
- Historia de Salud
- HIPAA Consentimiento
- FO24 - Autorizacion de divulgar informacion delcuidado de salud
Returning Patients (English)
- Medical and Dental History (update annually)
- FO24 - Authorization for the Release of Dental Record
- Medical Consultation Form
Volviendo Pacientes (Español)
Contact Us
Fax: 831-477-5687
Hours
Clinic opens
January 19, 2021
Tuesday-Friday
8:30am-4:30pm
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