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): 

• Smiley Doctor – Dental Health History Form

• Smiley Doctor – Dental Medical Evaluation Form

• Smiley Doctor – Transfer of Records Form