New Patient Forms


Good periodontal health begins with you. The first step is the most important. We invite you to call, make an appointment, and find out how we can begin the partnership that will give you lifelong dental health. 

Filling out these forms ahead of time will enable you to gather all the necessary information, which allows us to help you even more. Other items you should obtain ahead of time and bring with you, if appropriate, are:

  • Any referral form or information from your regular dentist 
  • Any x-rays 
  • Information about any dental insurance you have 
  • A list of any symptoms or signs of gum problems 


Please click below to access the forms:

Patient Registration Form


Medical Dental History Form


Insurance Responsibility Form

Arcadia Perio Care
1215 West Huntington Drive, Suite 3
Arcadia, CA 91007
Phone: 626-577-8880
Fax: 626-577-8811
Office Hours

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