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Complete your forms online

Save time during your first visit

You’ll need to provide contact information, insurance information, health and dental histories plus a list of current medications.

Time to complete: About 15 minutes

Fill out New Patient Forms online

English

Spanish

Returning Patient Forms

Update us on your health

You’ll need to provide your current contact information, answer some basic health questions and give us a list of your current medications.

Time to complete: About 10 minutes.

Fill out Returning Patient Forms online

English

Spanish


Pen and ink more your style? Print your own forms!

Download California Appointment forms to complete and print out before your visit.

You’ll need to provide contact information, insurance information, health and dental histories plus a list of current medications.

Time to complete: About 15 minutes

Download California Appointment Forms

Download in English

Download in Spanish

Download Arizona Appointment Forms

Download in English

Download in Spanish

Download Nevada Appointment Forms

Download in English

Download in Spanish


Western Dental office personnel will provide reasonable in-office assistance locating and providing patient paperwork in accessible formats or completing patient paperwork for patients who are blind or low vision upon request. For example, such materials may be made available online at https://www.westerndental.com/en-us or may be e-mailed by staff to patients who are blind or low vision at their request if the materials were created, prepared, provided or otherwise made available during an in-person office appointment. For more information, patients who are blind or low vision may also contact Western Dental’s Member Service Department at 1-800-992-3366, or email MemberServices@westerndental.com.

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