Pyramid Plaza Building 7434 Louis Pasteur, Suite #236 San Antonio, TX 78229

New Patient Forms

Download, Print & Complete Prior To 1st Visit

Email: drdaviddelagarza@gmail.com

Fax: (210) 614-2903

Phone: (210)681-1113

New Patient Checklist:

1. Bring ID (valid driver license or military id)

2. Proof of Insurance Card (if applicable)

3. Any dental x-rays taken within the last 6 months (full mouth x-rays series, panograph;if applicable)

Special Note:As a courtesy, we ask our new patients to arrive at least 10-15 minutes early to take care of any business matters. You are also welcomed to contact and review benefits with your dental insurance company. All co-insurance payments will be collected on the day of service.

Medical Note: Contact your physican if you have a history of surgical implant within the last 2 years (i.e hip and knee replacement) or any heart conditions. You may be subjected to preventive precautions for dental cleanings or treatment.

Thank you from the dental office of Dr. David De La Garza Jr. DDS.

Le damos las gracias de la oficina of denista Dr. David De La Garza Jr.

This web site uses files in Adobe Acrobat Portable Document Format

(pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.