Patient Registration Forms

New to our Clinic? If you would like to expedite your wait time, you may download our patient registration forms here and fill them out prior to your appointment date and time!

ADULT PATIENTS – Please complete each form below

Patient Consent for Treatment Form (ENGLISH / ESPAÑOL)

Patient Registration Form (ENGLISH / ESPAÑOL)

Patient Privacy Rights (ENGLISH / ESPAÑOL)

Advance Directive Information

PEDIATRIC PATIENTS (up to age 18) – Please complete each form below

Patient Consent for Treatment Form (ENGLISH / ESPAÑOL)

Patient Registration Form (ENGLISH / ESPAÑOL)

VFC Eligibility Screening (ENGLISH / ESPAÑOL)

Authorization for Alternate Adult/Guardian Clinic Visits (ENGLISH

DENTAL PATIENTS – Please complete each form below

Patient Consent for Treatment Form (ENGLISH / ESPAÑOL)

Patient Registration Form (ENGLISH / ESPAÑOL)

Oral Health Risk Assessment (ENGLISH )