Patient Forms

Please take a minute to print and fill out the patient information form before your first appointment:

Orthodontic Forms

• New Patient Health History Form (Child) PDF | DOC
• New Patient Health History Form (Adult) PDF | DOC
• Online Medical History form PDF

Pediatric Forms

• New Patient Health History Form (Child) PDF (English) | DOC (Spanish)
• Recall Patient Health History Update Form- PDF (English)| DOC (Spanish)

Please download Adobe Fill & Sign App, click here for iphone or ipad or click here for Android/Google phone to fill out form directly.  Please first save form to your device before using the app to fill it out and send us back by email to kiferpedo@gmail.com or text to (408) 799-5508.  

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