925.778.2100

ORAL AND MAXILLOFACIAL SURGERY

Patient Forms

 

So that we may ensure the quality of your care, and save you time at your appointment, prior to your first visit we ask that you print and complete the 'Patient Registration' questionnaire.

We ask that you bring your forms with you to your appointment or email them to Info@EastCountyOralSurgery.com. If you are unable to complete the forms, please come no later than thirty minutes before your appointment to complete the forms.

 

Please be aware that if you have any existing medical conditions a medical summary from your provider will be required. If you have questions regarding the medical summary please contact our office. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Please read the Notice of Privacy Practices.

» Patient Registration «

» Notice of Privacy Practices «