New Patient Forms

To make your visit to our Lodi clinic for your whole family needs and as convenient as possible,

We will text or email you the new patient forms, so you can fill it up on the go.

You can also print a copy and fill in the information at your convenience.

 Please read the Notice of Privacy Practices before you sign Consent .

NEW PATIENT REGISTRATION AND HISTORY FORM

Dental Registration Form (.pdf)

NOTICE OF PRIVACY PRACTICES

Notice Of privacy Practice Form (.pdf)

OTHER FORMS:

PATIENT RECORD RELEASE AUTHORIZATION FORM

Release of Dental Records (.pdf)

Technical Note:You need Adobe Acrobat Reader to view some of our forms. Please download it from Adobe's web site if it is not already installed on your system

Lodi Dentist providing the professional services .Dr. Mary ali is a well-trained Lodi Dentist providing the complete dental services to Lodi Ca community include Teeth cleaning | teeth whitening |children Dentistry| cosmetic dentistry | Oral Hygiene instructions | Complete Dental Exam | Digital X-Rays | Fluoride Treatment |Sealants | Amalgam fillings | Composite white Fillings | dental Crowns | Fixed Dental Bridges | Veneers | Periodontal Disease | Dental Implants | Restorations | Dentures complete and Partial | Root Canal Therapy | night guards | Extractions | denture repairs | Periodontal Treatment, Porcelain Crowns and much more.