Directions

2225 Buchanan Rd #A Antioch, CA 94509

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 (Please use doctor email:dentalantioch@gmail.com

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Appointment:

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

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You can pay using any below:

• Zelle: smileydoctor@gmail.com / 650-965-2929
• Venmo:  smileydoctor
• 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 – Dental Medical Evaluation Form

• Smiley Doctor – Transfer of Records Form