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)
- KDS Office Policies
- REQUEST-Record Release
- Post-Dental Treatment Instructions
- OHA-English
- GUIDELINES for PARENTS
- KDS Caries Risk Assessment
- CAT (Caries-risk Assessment Tool) form
- Care Instructions for Stainless Steel Crown (SSC)
- Care Instructions for Space Maintainer
- AUTISM questionnaire
- REQUEST-Record Relase via email
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.