Directions
373 South Monroe Suite 203 San Jose CA 95128
Patients going to “San Jose” office, kindly complete the forms below:
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Patient insurance form
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Medical history
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Dental treatment consent
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HIPAA information
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Financial policy agreement
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HIPAA acknowledgment
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Covid 19 Patient screening (Please use doctor email: smileydoctor@gmail.com)
Appointment:
Please take the appointment using here: appointment with Dr. Reena Gupta
You can pay using any below:
- Zelle: smileydoctor@gmail.com / 650-965-2929
- Venmo: smileydoctor
- Paypal : https://paypal.me/smileydoctor
Paper Forms (Only used when the patient is in the clinic):
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Smiley Doctor – Dental Health History Form
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Smiley Doctor – Dental Medical Evaluation Form
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Smiley Doctor – Transfer of Records Form