Dental Care & Forms

Step 1: Web Forms   – Paperless 

  1. Patient insurance form

  2. Medical history

  3. Dental treatment consent

  4. HIPAA information

  5. Financial policy agreement

  6. HIPAA acknowledgment

  7. Covid 19 Patient screening

Appointment:

Please take the appointment using here:  appointment with Dr. Reena Gupta

Payment:

   You can pay using any below:

  • Zelle: 408-394-2672
  • Venmo:  smileydoctor

Paper Forms (Only used when the patient is in the clinic):