Patient Forms

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

Download
New Patient's Form
Scan1.pdf
Adobe Acrobat document [80.4 KB]
Download
Health History Form - Part 1
Scan20002.pdf
Adobe Acrobat document [456.4 KB]
Download
Health History Form - Part 2
Scan20003.pdf
Adobe Acrobat document [413.0 KB]
Download
Treatment Consent
Treatment Consent.pdf
Adobe Acrobat document [229.1 KB]
Download
Visit Needs Checklist
Scan2.pdf
Adobe Acrobat document [502.2 KB]
Download
Our Financial Policy
NEW FA (1).jpeg
JPG image [650.4 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.

Download
Privacy Notice
notice_of_privacy_practices(1).pdf
Adobe Acrobat document [214.9 KB]

Request an

Appointment!

 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

Mon 9 AM - 6 PM

Tue 9 AM - 6 PM

Wed  CLOSED

Thr 9 AM - 6 PM

Fri  7 AM- 4 PM

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

Get Social With Us

Keep Your Teeth Healthy!

What is the best preventive care for your teeth? Find out how to make your next visit easier and more pleasant.

Print | Sitemap
© Peninsula Dental Care

Web ViewMobile View

Logout | Edit page