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Appointment Request
The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone (650.365.1533) or complete the appointment request form below.  Sherri. our scheduling coordinator, will contact you to confirm your appointment.

New Patients can download the Health History Form and New Patient Information Form to complete prior to your visit.  Otherwise, please plan to allow 15 minutes prior to your appointment to complete the forms in our office.

 Confidential Health History form.pdf

PATIENT INFORMATION FORM.doc


Please do not use this form to cancel or change an existing appointment.
Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Phone:
Email:
Are you a current patient?
Best time(s) to call?
Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):
 
 

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.