Rancho Penasquitos Patient Rewards Program

 

Patient Forms

Please submit a Health History Form either online (preferred method) or to our office before or at your first appointment. Thank you and we are looking forward to seeing you soon.

  • Digital Health History Form
    (this is a secure form to be completed online)

  • PDF Health History Form
    this version can be completed, printed, and submitted to our office as a hard copy

  • Notice of Privacy Practices
    (This form details the office policies with regards to your personal health information. It is in accordance with the current HIPPA regulations. You may download this form and keep a copy for your records or access it here anytime.)

  • Acknowledgement of Privacy Policy
    (This form is to be downloaded, filled out and returned to our office either electronically or in person. We will keep a copy on file for you.)

Additional Forms

 Please download Adobe Acrobat below to view/print forms:

 

 
Rancho Penasquitos Orthodontics