Please complete and submit forms before appointment:
Complete y envÃe los formularios antes de la cita:
- Patient insurance form
- Medical history
- Dental treatment consent
- Financial policy agreement
- HIPAA information
- HIPAA acknowledgment
Extra Forms (if needed)
- Covid 19 Patient screening (Please use doctor email: smileydoctor@gmail.com)
- Address / Insurance update ( Please use this form if there is any update to address or insurance information)
373 S Monroe St #203, San Jose, CA 95128
Appointment:
Please take the appointment using here: appointment at Smileydoctor San Jose
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