Please call our office to make an appointment @ 707.658.2320
Some Useful Forms for Patients
Before your appointment please fill out these secure online forms.
ONLINE PATIENT MEDICAL HISTORY, INFORMED CONSENT & FINANCIAL POLICY AGREEMENT
Please also read and sign the Petaluma Kids Dental Care Notice of Privacy Practices and HIPAA Notice of Privacy Practices. You can do so securely online.
PETALUMA KIDS DENTAL CARE NOTICE OF PRIVACY PRACTICES
HIPAA NOTICE OF PRIVACY PRACTICES
If you prefer, you can download the the forms below, fill them out, save them to your computer and email them to us at: firstname.lastname@example.org. These fillable forms require Adobe Reader which you can download free here:
You must open the form in Adobe Reader to fill in the form on your computer.
You can also print the forms, fill them out and bring the completed copies with you to your next appointment. These patient forms will help us provide the individual care your child needs.
DOWNLOADABLE PATIENT MEDICAL HISTORY, INFORMED CONSENT & FINANCIAL POLICY AGREEMENT