COVID-19 Treatment Consent Form
Waiver must be signed before recieving treatment at Kids Dental Specialty
New Patient Forms & Patient Survey
(Complete Both New Patient Forms & Patient Survey)
If your child is a new patient to our office please fill out the following forms so we can expedite your first visit. Completing these forms prior will allow us to attend to your medical needs more quickly than completing them on your arrival. Thank you and please call our office (909) 333-7457 if you have any questions at all.
New Patient Forms
Patient Survey
Additional Forms for your reference: (Printing Optional)
- REQUEST-Record Release
- REQUEST – Records Release via Email
- GUIDELINES for PARENTS
- Care Instructions for Stainless Steel Crown (SSC)
- Care Instructions for Post IV Sedation
- Care Instructions for Post OP Extractions
- Care Instructions for Lip biting injury
- Nitrous Oxide Consent and Guidelines
- Oral Health Assessment Form – English
- AUTISM questionnaire
- Behavior Management Consent
This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.