Directions

373 South Monroe Suite 203 San Jose CA 95128

Patients going to “San Jose” office, kindly complete the forms below:

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: smileydoctor@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