New Patient Forms | David De La Garza Jr., DDS | San Antonio Dentist
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New Patient Forms
Download, Print & Complete Prior To 1st Visit
Phone: (210)681-1113 Fax: (210)614-2903 Email: email@example.com
New Patient Checklist:
1. Bring ID (valid driver's 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) Please note: you may have a co-payment if x-rays are not covered by dental insurance.
Special Note: As a courtesy, we ask our new patients to arrive at least 30 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 physician if you have had surgical implants within the last 2 years (i.e hip/knee replacement, dialysis 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., D.D.S.
Le damos las gracias, de la oficina del Dr. David De La Garza, Jr., D.D.S.
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