Online Forms

New Patient Forms

Get
Acquainted

New patient information.
Only one form needed per family.
Download

Medical
History

Medical history for the child.
Please fill out one form per patient.
Download

Billing
Forms

Our office's Missed Appointment Policy and Credit Card Authorization
Download

Existing Patient Forms

Release of
Records

Request to transfer records to another
office
Download

Oral Health
Assessment

Kindergarten oral health assessment
form
Download

Nitrous Oxide
Consent Form

Informed consent paperwork for
nitrous oxide
Download

Emergency Visit
Registration

Patient paperwork for an
emergency visit
Download

Missed Appointment
Policy

Our office's missed appointment
policy
Download

Credit Card
Authorization

A form to securely leave a credit card
on file within our office
Download

Referring Doctors

Referral Form

Click here to download
our office's referral form
Download
COVID-19 Procedures

Our office is committed to your child's health.

We want you to know that we are committed to providing you child the best dental care in the safest environment possible. Here's just a few things we're doing to keep you safe:

One family in the office at a time
Increased personal protective equipment
Staff and patients screened
Office disinfected between patients
1223 Grant Ave, Ste A
Novato, CA 94945

Mon:  9:00 AM - 5:00 PM
Tues:
10:00 AM - 6:00 PM
Wed -
Fri: 9:00 AM - 5:00 PM
Sat - Sun:
Emergencies Only