Click here to view and print the
New Patient Health History Form

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Consent and Information Form

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Notice of Privacy Practices

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Answers to Dental Insurance Questions

When visiting our office for the first time, the above forms must be completed.  For your convenience we have made the forms accessible to you to complete and bring with you on your first visit.

You will need Adobe Acrobat Reader to view and print these forms.  If you do not have Adobe Acrobat Reader click here to download it for free. 

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© Copyright 2001-2006 Craig R. Bergquist, D.D.S., Inc. & Richard C. Wittenauer, D.D.S. - All Rights Reserved.
San Clemente Endodontics, San Clemente, CA

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