Please visit our Patient Registration page to complete and submit this paperwork securely from the comfort of your home. If you have any questions, please call us at (510) 652-2603.

As an alternative, feel free to download, print, and fill out the appropriate paperwork PRIOR to your child’s visit. You can then bring the completed papers to your first visit, which will reduce your wait time.

• COVID-19 Patient Screening Form | Español
• Caries Risk Assessment 0-5 Years
• Caries Risk Assessment 6 Years & Older
• HIPAA Privacy Act
• Doctor Referral
• New Patient Health History Form
• Existing Patient Health History Update Form

Doctors can use this form to refer patients to our office. After completing the information, you may fax it to our office at the number listed on the form. If you have any questions, please call us at (510) 652-2603.