Forms

We are happy to offer our forms and applications for download.  Please feel free to print these and fill them out at your convenience before your visit.  Please do not email these forms over the Internet.

Registration and Health History

Please complete the form and bring it to your first dental appointment.
Click here to download (684KB)

Office Policies

Please complete the form and bring it to your first dental appointment.
Click here to download (137KB)

Dental Board Form

Please complete the form and bring it to your first dental appointment.
Click here to download (10KB)

HIPAA

Please complete the form and bring it to your first dental appointment.
Click here to download (18KB)

Getting to Know You

This form needs to be filled out before your first dental appointment.
Click here to download (75KB)

 
If you are unable to view the pdf files, please click on the icon below to download and install Adobe Reader:

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Alan Golshanara, DDS MAGD FICOI
6600 Mercy Court Suite 220
Fair Oaks, CA 95628
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Phone: (916) 965-7036
 

 

Office Hours:
Mon 8:30am - 5:30pm
Tues 8:00am - 5:00pm
Wed 8:30am - 5:30pm
Thur 8:00am - 5:00pm
Fri Closed
Sat Closed