West Portal Dental Care, 48 Vicente St, San Francisco, CA 94127
New Patient Forms

formIf you would like to complete your registration forms before you arrive, you may download them by clicking below. The new patient forms are in PDF format. If you do not have Acrobat Reader, get a free copy by clicking on the link below. Also, after reading the Notice of Privacy Practices, print the Acknowledgement form, sign it, and bring it in, too.

Adobe PDFAdobe ReaderPatient Registration (Acrobat PDF form)

Adobe PDFDental/Medical History (Acrobat PDF form)

Adobe PDFPayment Policy (Acrobat PDF form)

The Dental Board of California now requires that each patient be provided a copy of The Dental Materials Fact Sheet (available in English, Spanish, and Chinese) prior to any restorative work. You may download this brochure from the link above and, after reading it, print and sign the acknowledgement form below.

Adobe PDFPatient Acknowledgment of Receipt of Dental Materials Fact Sheet (Acrobat PDF form)

 

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© Copyright 2005- Dental WebSmith, Inc. and West Portal Dental Care. All rights reserved worldwide. Disclaimer: The information provided within is intended to help you better understand dental conditions and procedures. It is not meant to serve as delivery of medical or dental care. If you have specific questions or concerns, contact your health care provider.

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