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

Location
Arcadia Perio Care
1215 West Huntington Drive, Suite 3
Arcadia, CA 91007
Phone: 626-385-4812
Fax: 626-577-8811
Office Hours

Get in touch

626-385-4812