English Forms

• New Patient Questionnaire
• Medical History Form
• Consent for Use and Disclosure of Health Form
• Patient Records Release Form
• Patient Medical Consultation Request
• Office Policy Regarding Patients with Treatment Form
• Acknowledgement of Receipt Notice of Privacy Practices Form
• Financially Responsible Adult-form
• Office Financial Policy Form

Spanish Forms

• Acknowledgement Hippa
• Hippa Office Policy
• Informed Consent
• PHI Consent
• Medical History

Welcome New Patients

Experience The DETAIL DENTAL Way!

Within the first few moments of walking into our office, you’ll realize things are a little different here.  First, you’ll be warmly greeted by one of our business assistants providing you with an Amenities Form asking what we can do to make your visits as pleasant as can be.

COME JOIN OUR IN HOUSE MEMBERSHIP PLAN!

New Patient Comprehensive Exam 100%

Two Cleanings Per Year 100%

Two Exams Per Year 100%

Fluoride Varnish 100%

Emergency Exams 100%

Radiographs 100%

Plus 20% Discount on ALL Other Procedures!

MEMBERSHIP PLAN DUES

1st Member $425.00/ year or $39.00/ month

2nd Member $325.00/ year or $29.00/ month

Each Additional Member $275.00/ year or $29.00/ month

Optional Additional Perio Plan $325.00/ year or $29.00/ month

*one time $59.00 initiation fee/ per member if paying monthly