Patient Forms

New patient? Please download and fill out ALL the following forms :

New Patient's Form
Scan1.pdf
Adobe Acrobat document [80.4 KB]
Health History Form - Part 1
Scan20002.pdf
Adobe Acrobat document [456.4 KB]
Health History Form - Part 2
Scan20003.pdf
Adobe Acrobat document [413.0 KB]
Treatment Consent
Treatment Consent.pdf
Adobe Acrobat document [229.1 KB]
Visit Needs Checklist
Scan2.pdf
Adobe Acrobat document [502.2 KB]
Our Financial Policy
financial policy form.pdf
Adobe Acrobat document [27.5 KB]

Privacy Notice

Please read over and sign our Notice of Privacy Practices, acknowledging our privacy policy. This form should also be brought to your first appointment.

Privacy Notice
notice_of_privacy_practices(1).pdf
Adobe Acrobat document [214.9 KB]
Click Here!

 Or call us today at:

650-701-1122

 

Peninsula Dental Care

1122 Hopkins Ave

Redwood City, CA 94062

Fax: (650) 556-1122

Email:

 info@peninsuladentalcare.com

 

Use our contact form to get in touch.

Office Hours

09:00 AM -06:00 PM  Mon-Fri

09:00 AM-06:00 PM     Sat

 

Outside our regular business hours, please note our Dental Emergency Care information.

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