You may download the following forms for completion prior to your visit to save time.  Please bring them with you to the first appointment.  You may edit the History and Consent Form from this site with your information and print a copy.  (No data will be saved)  For fastest service,  FAX to (408) 249-5123  or mail to Dentistry for Children of Santa Clara, 2790 Newhall Street, Santa Clara, CA 95050.  You may also print the blank form and  complete it by hand.  Please print legibly.

History and Consent Form

This information allows us to establish your account, review relevant medical history, and document your consent for treatment on your child.  You may complete this form and print from your computer

Authorization for the Release of Dental Records

This consent allows consent from you to allow us to forward copies of your child's dental records to the person of your choice. This form is necessary only if you should wish to have records sent to another office.

Authorization for Agent to Consent 

This form is necessary only if you should wish to allow another responsible adult to bring your child to a dental visit and make informed decisions for diagnosis or treatment.