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Mary Ali, DDS, Inc. | New Patient Forms in Lodi

LODI FAMILY DENTIST

 Mary Ali, DDS, Inc.

 

Lodi Family Dentistry ,
525 S. Fairmont Ave., Suite H
Lodi, CA 95240

Gentle Dental care for the whole family.

209-369-2696

New Patient Forms
 

New Patient Registration

To make your visit to our lodi family practice as convenient as possible, below are new patient registration forms .You can print a copy at home and fill in the information at your convenience. Then just bring the completed forms with you to the clinic for your appointment. Please read the Notice of Privacy Practices before you sign Consent .

NEW PATIENT REGISTRATION AND HISTORY FORM

Microsoft Word document (.doc)
Adobe Acrobat document (.pdf)

NOTICE OF PRIVACY PRACTICES

Adobe Acrobat document (.pdf)

OTHER FORMS:

PATIENT RECORD RELEASE AUTHORIZATION FORM

Microsoft Word document (.doc)
Adobe Acrobat document (.pdf)

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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.

 

 
 
 
Lodi Dentist | New Patient Forms. Mary Ali is a Lodi Dentist.

Lodi Best Dentist, Doctor MARY ALI DDS, offer in Lodi ,CA services for the family family, restorative, cosmetic and childrens dentistry and offers services that include: Teeth cleaning and whitening , dentures, complete dentures and partial dentuures , root canals, tooth colored white fillings, digital x-rays & veneers. Offering care credit and  monthly financing options and accepting most dental ppo insurance. serving the Lodi, centeral valley including Galt,Acampo, Lockeford, Stockton, Valley Springs, Morada, Woodbridge and Jackson, CA.