Here you will find pre-appointment dental documents and forms that you can fill out online or print and bring with you to your visit.

Notice of Privacy PracticesTHIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATIONDownload PDF
Print Only
General Dentistry Consent FormAUTHORIZATION OF TREATMENTDownload PDF
Print Only
Acknowledgement of Receipt of
Privacy Practices
And
Dental Material Facts Sheet
ACKNOWLEDGMENT FORMDownload PDF
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Financial ConsentOUR FINANCIAL POLICIESDownload PDF
Print Only
Health History FormPATIENT INFORMATION FORM
This form has a printable version and one that can be filled out and submitted by email
Print PDF

Editable PDF

If you have any questions about Fluoride treatment and you live in or around Cameron Park, give us a call today! We’re located in the Safeway Shopping Center off highway 50.