1863 Alum Rock Avenue, Suite C

San Jose, California 95116


Patient Forms

For your convenience, please complete and submit the following appropriate new patient forms prior to your first appointment.


Special Notice: If you are using Safari for Mac or Google Chrome you will need to download, print and bring these forms with you to your first appointment. These browsers are not compatible with Adobe Reader and will not submit your forms to our office properly. We apologize for this inconvenience.


New Patient Form: Child

New Patient Form: Adult


American Association

of Orthodontists


American Dental