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The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone at (650) 474-0551 or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

 

Would you like to save time before your first appointment?  Download and print out these new patient forms (pdf. files).  Fill them out ahead of time at your convenience and then bring them to your first appointment.

New Patient Information Form

Health History Form

Payment Policy Form

Contact Preference Form

Please do not use this form to cancel or change an existing appointment. If appointment changes are necessary, please call us at (650) 474-0551.

 

*Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Email:
Phone:  
Are you a current patient?
Best time(s) to call?

Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.