Registration Information

Dr. Curtis J. Perry

New Patient Forms…

The following downloadable forms and brochures are provided for your convenience. You may click on the Quick Link above to the right labeled ‘Fill in New Patient Forms Online‘ which will allow you to complete all three required forms or you may download and email, fax or bring in the three completed forms for your first appointment with you. Signatures are required by Federal or State governments that all patients received HIPAA and Dental Materials Fact Sheet. The relative two booklets are at the bottom of this page for download. All forms are saved in Adobe Acrobat format. If you do not have the free Adobe Reader software required to view these documents, please click here to download it.


Download Patient Registration Form  [NEW PATIENTS – Please Download This Form]
Download Dental/Medical History Form  [NEW PATIENTS – Please Download This Form]
Download
Download Welcome Form
Download Informational Brochure About Our Practice
Download Health Insurance Portability and Accountability Act of 1996For more information: www.HIPAA.org)
Download The Dental Board of California Dental Materials Fact Sheet
For more information: www.dbc.ca.gov

Click here to fill registration forms online