Patient forms
Save time at your next visit by filling out patient forms in advance.
You can complete them online or on paper.
Answer a few questions before your visit
We ask all new patients, and returning patients who haven’t visited in a while, to fill out a patient form before their appointment. You will be asked to provide:
- Your current contact information
- Your dental and health history
- A list of your current medications
- Your insurance information
Time to complete: ~15 minutes
Online new patient forms
Submitting a new patient form online is easy. You’ll be asked to provide your contact details, insurance information, and health history.
Online returning patient forms
Been a while? If you’re a returning patient, make sure your information is up to date by filling out a returning patient form before your next appointment.
Print-out patient forms
Rather fill out a physical copy? Download an appointment form for your state, add your information, and bring the completed form to your visit.
Download California appointment forms
Download in English
Download Arizona appointment forms
Download Nevada appointment forms
DISCLAIMER: 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://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.