Patient Forms

NEW PATIENT INSTRUCTIONS

We need some information about you in order to to begin the new patient process. Once we receive your information we will contact you to schedule or confirm your appointment. Please choose from one of the following options to submit your information:

OPTION #1 - ONLINE SUBMISSION

1. Click HERE - A new window will open a DocuSign PowerForm.

2. Enter your full name and email to begin filling out your new patient information.

3. Press Finish to send us the completed forms.


OPTION #2 - PRINTED COPY SUBMISSION

1. Click HERE - A new window will open allowing you to print and fill out your new patient information.

(Only complete "Assignment of Rights and Benefits" if you have dental insurance coverage.)

2. Choose one of the following ways to return forms:

     1) Take photos of completed forms and text images to: (925) 682-8566

     2) Take photos of completed forms and email to: concorddentalgroup@yahoo.com

     3) Fax completed forms to: (925) 682-8478

     4) Mail or drop-off completed forms to: 5167 Clayton Rd., Ste. C, Concord, CA 94521


ADDITIONAL INFORMATION

The following forms are for your information. Please review.

Dental Materials Fact Sheet 

Notice of Privacy Practices