Dentist Santa Rosa New Patient Paperwork

To continue making your dental experience pleasant, we have conveniently provided our dental forms below. You can fill them out in the comfort of your home and bring them with you to your New Patient Appointment. If you choose to, you may Email or Fax them ahead of time..

 

Fax: 707-571-7908

Email: Lwesterberg@Yahoo.com

 

 

Notice of Privacy Policy (HIPPA)  

Dental Health History 

Child Health History (Under age 18)

Financial Policy

Dental Material Facts Sheet 

Signature Sheet For Dental Materials & HIPPA Forms 

Record Release Form