Patient Forms

To all our patients, established and new:

It’s a matter of liability –

We are all asked to sign forms of authorization wherever we do business these days. None of us like it, so why is it done?

Did you know that state and federal laws regulate the way we collect and store your private records in this office? Further, we are required to inform you of these regulations and acquire your authorization of such. These regulations directly influence our liability coverage and without strict compliance we could not be open for business.

Forms like our HIPAA Privacy Policies need only be signed once per patient. The Medical History form needs to be reviewed and signed yearly per patient. Forms for specific authorization need only be signed per incident like our Treatment Consent.

Please know that none of us enjoy reading and authorizing what might seem to be endless forms. To help streamline the process, we will make forms available on line by request. You will always have the option to review, fill out or authorize any form on paper.

We thank you for your understanding and cooperation. Every effort will be made to make your visits in our office as easy and uncomplicated as possible. Let us know if you have any questions or suggestions regarding the required authorization in our office.

Yours for better dental health,

Dr. Maria Elena Tapia
and Team

New Patients:

Please complete all seven forms listed in the left column. Some forms will require you to scroll down, so please enter all necessary fields and click ‘Submit’ at the bottom of each form. Please note HIPPA forms and Office Policies only required a digital signature. The Comparison of Restorative Materials is provided for your review, as required by the dental board of California, but does not require any entries.