New Patient Forms for Menlo Park Dental Excellence

We are happy to offer our patient forms online. Please feel free to print and fill them out at your convenience before your visit.

New Patient Registration

Please download, print and complete these forms before your first dental appointment.

• Patient Registration Form
• Patient Information
• Dental History

Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information.

HIPAA Form

Please download, print and complete this form before your first dental appointment. This form confirms that you read our Notice of Privacy Practices.

• Dental Treatment Consent
• Scaling & Root Planing
• Root Canal Treatment
• Tooth Extraction
• Implant Placement
• After Surgery Form
• Post Op Endodontic Instructions
• Authorization to Duplicate, Use, or Disclose Protected Health Information