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Patient Info

Forms for your first visit

What new patients fill in, and the details that make it quick.

If you are a new patient to our office, there are a few forms that will need to be filled out when you arrive.

Having your details to hand lets us attend to you more quickly than working them out on arrival. Please call our office if you have any questions at all.

The new patient bundle

What you will be asked to complete

  • Registration

    Your contact details and emergency contact, your primary and any additional insurance, and an assignment of insurance benefits.

  • Medical information

    Your physician, any serious illnesses or operations, allergies, current medications, and a checklist of medical conditions.

  • Dental information

    Why you are visiting, your last dental visit and previous dentist, whether treatment makes you nervous, and how you feel about your smile.

  • Office financial policy

    How payment and insurance claims are handled, signed by the person responsible for the account.

  • Consent for use and disclosure of health information

    Your consent for your records to be shared where needed — for example with your insurer, or other providers involved in your care.

Before you arrive

Details to have ready

  • Your insurance details

    The insurance company, and the contract or group and subscriber numbers, for your primary and any additional plan.

  • Your physician

    Their name and phone number, and the date of your last visit.

  • Current medications

    Including aspirin and over-the-counter medication.

  • Allergies

    Including to medication, latex, jewelry or metal.

  • Your previous dentist

    Their name, address and phone number, and roughly when you were last seen.

  • Photo ID

    Required if you are paying by check.

Related care

Where to go next

New patients

New patients are welcome

Your first visit begins with a thorough examination to assess your dental health and discuss your concerns and goals.

  • 11717 Bernardo Plaza Ct Ste 100, San Diego, CA 92128
  • Mon–Fri 8:00 AM–5:00 PM
  • Get directions