Patient Forms

Please download and fill-out our New Patient Registration and Patient Health History form.  After you have completed the forms, please fax, mail or email it to us prior to your first visit to our office.  Having the completed form in advance will help us prepare better for your visit.  The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Mail or visit:

1390 El Camino Real, Suite 150
San Carlos, CA 94070

Fax: (650) 394-4202

Email: info@PeninsulaKidsDDS.com

The forms are in Adobe PDF format:

New Patient Registration and Health History Form

Office Policy