Patient Registration Forms

PATIENT REGISTRATION FORMS

Please download, print, and fill-out our Patient Registration Forms. After you have completed them, please make sure to bring them on your first visit to our office. We look forward to helping you achieve a healthy and beautiful smile!

Health History Form .pdf ( 2 Pages)

Cancellation and Appointment Reminder Preferences.pdf

SCD Privacy Practices Notice.pdf ( 2 Pages)

Technical Note:

You need Adobe Acrobat Reader to view our form. Please download the free Acrobat Reader from Adobe’s web site if it is not already installed on your system.

Location

19366 Soledad Canyon Drive, Canyon Country, CA 91351

Phone: (661) 252-8888

Email: [email protected]

Fax: 6612528808

  • MON - FRI: 9:00 am - 6:00 pm
  • SAT: By appointments only.
  • SUN: Closed
Contact Us

23884 Copper Hill Drive, Valencia, CA 91354

Phone: (661) 702-9595

Email: [email protected]

Fax: 6617029595

  • MON - THU: 9:00 am - 6:00 pm
  • FRI: 8:30 am - 5:00 pm
  • SAT: By appointments only.
  • SUN: Closed
Contact Us