Patient Forms

We Are Dedicated to Minimize Your Wait Time

As we welcome you to our practice, and we are honored that you are considering us for your dental care. We are looking forward to meeting you. The following forms allow us to get to know you better, and to help make your visit to us pleasant and organized. It is very important that you return this information to us before your first appointment with us. Medical conditions that are unknown to us may prevent us from performing a comprehensive exam. Knowing your past dental history and your goals allows us to formulate treatments that are tailored to your desires. Most importantly, having the most recent x-rays and information from your previous dentist may save you time and the costs of retaking them if they are current enough (less than 6 months old). By receiving this information prior to your appointment, we can enter insurance benefits into our computer system so that we can estimate what it will cover for you. This can be done in several ways.

1. You can print out the forms and send them to us in the mail. Our address is:

Dentistry of Thousand Oaks, 227 West Janss Road Suite 140, Thousand Oaks, CA 91360

2. You can print out the forms, and fax them. Our Fax number is (805) 495-5994

Please print out the form below and fill out to bring in to your first appointment. Thank you and we are looking forward to seeing you soon.

• Patient Information
• HIPAA Form

Please download Adobe Acrobat below to view/print forms: