For your convenience, your new patient paperwork can be accessed online and completed right on the screen. Simply follow the links below to our secure server, complete the forms on the screen and submit. If you should have any difficulty completing these online forms, please call our office and a SLO Smiles staff member will be happy to assist you.
Patient Portal → Pay Bill Online →
Complete New Patient Forms are important to the success of your first visit and are required before your appointment day. Please complete them as soon as possible by following the links below. Some are required, some are optional, as noted. If we have not received your patient forms ahead of time, your appointment will be rescheduled.
New Patient Required Forms:
Patient Information Part I
Patient Information Part II
Health History
Dental History
HIPAA Privacy Notice
Optional Forms:
COVID-19 Patient Screening Form: Please, no sooner than two days before your appointment.
Insurance Information: As a new patient, if you have dental insurance, you must complete this form. If you have had a change of insurance, you can use this form as well! All insurance information must be in place ahead of your new patient visit to be used that day. Please call the office if you need assistance!
Credit Card Authorization Form: We encourage contactless payment, and can run your charge card for the amount due after your visit.
Authorization to Release Records: Permission to talk to another about your care here. This is required for adult children when parents want to be involved in care and accounting.
Sleep Apnea Questionnaire: For new or established patients who are having symptoms of or wish to be screened for sleep apnea.
Health History Update: For returning patients who haven’t been in for a while or have had changes to their overall health.
Patient Documents
Notice of Privacy Practices
Direct and Indirect Restorative Materials
Medication List
