New Patient Form

What you should know about your first visit to Salinas Pediatric Dental Center

Prior to your exam, you’ll complete a health history for your child which helps us identify oral and overall health issues we should watch out for. The form is available on this page. While you may be surprised at the thoroughness of the form, we believe it’s important we have all relevant information as part of your healthcare team, and it’s an important step in helping us care for your child properly.

What you should bring to your first visit:

1. Dental insurance card, if applicable
2. Photo ID card
3. Completed new patient forms

Instructions for New Patient Form

We’ll need the information on the form prior to getting started. Please download the form, complete it and bring it to your first visit. If you are not able to complete these forms prior to your first visit, please arrive 10 minutes before your scheduled appointment.

The form is a PDF and requires you have Adobe Reader to open it. (Nearly all computers have this. If you cannot open the form, you can download it here:   Adobe Reader.)

After opening the form, you can place your cursor in the text fields and type your answers. You can also click the appropriate selections to choose Yes/No, etc.

To print the form from your computer:

1. Choose File > Print or click   icon in the toolbar

2. Select a Printer

3. Click Print