Patient Forms

We have made it very easy for you to securely fill out forms online in the comfort of your own home or office. This will allow you to be seen in a timely manner if this is done in advance.

We are an environmentally-friendly dental office that does not have physical charts or paper. We maintain a technologically-advanced, hygienic, paperless electronic dental chart.

Please fill out the form below to complete and submit it prior to your visit. Please allow about 15 minutes to fill it out. Dr. Amin relies on this form to help give you the best dental implant care possible. It will speed up your visit tremendously if this is filled out before your appointment.

CLICK ON THE RED “NEW PATIENT” BUTTON TO START THE FORM

NOTE: New patient forms can be filled out WITHOUT an appointment date. Fill out any random date if you are unsure of your appointment time in the mm/dd/yyyy format.

Be sure to click “SUBMIT” at the bottom of the form.