2225 Buchanan Rd STE A, Antioch, CA 94509

Web Forms   – Please fill these forms before your appointment 

1. Patient insurance form
2. Medical history
3. Dental treatment consent
4. HIPAA information  
5. Financial policy agreement
6. HIPAA acknowledgment  

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Appointment:

Please take the appointment by calling 925-727-3141

OR

Click here:  Appointment at Smileydoctor Dental Clinic Antioch 

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You can pay using any below:

• Zelle: smileydoctor@gmail.com / 650-965-2929
• Venmo:  smileydoctor ((Please give 4 digits as 2672 if venmo asks )
• Paypal : https://paypal.me/smileydoctor

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

• Smiley Doctor – Dental Health History Form
• Smiley Doctor –  Medical Evaluation Form
• Smiley Doctor – Transfer of Records Form