In pain? Call (626) 323-9443 for same-day care. In pain right now? Call (626) 323-9443 — same-day emergency appointments available.
Complete your paperwork from home and walk into our Glendora office ready for a relaxed, efficient first visit.
Before Your Visit
If you are a new or returning patient at Glendora Healthy Smiles, a little paperwork comes before every appointment. We have put our patient forms online so you can fill them out at your own pace, from your couch, your car, or wherever you have a few quiet minutes, instead of rushing through them with a clipboard in our waiting room.
Completing these forms ahead of time gives Dr. and our clinical team an accurate picture of your health, your dental history, and your insurance coverage before you even sit in the chair. That means less time spent on administrative details and more time addressing what actually brought you in, whether it is a routine cleaning, a toothache, or a conversation about cosmetic options.
Below you will find every form we ask new patients to complete, along with a short explanation of what each one covers. If you have questions about any section, our front desk team in Glendora is happy to walk you through it over the phone before your appointment.
Click "View Form" on each item below to open, print, or save the document. If you would rather complete your forms in our office, print copies are available at the front desk when you check in.
Your contact details, emergency contact, and preferred method of communication so our team can reach you when needed.
View FormA summary of current medications, allergies, and any health conditions that could affect your dental treatment.
View FormNotes on past dental work, previous concerns, and any anxiety or sensitivities we should know about before treatment.
View FormYour carrier, member ID, and plan details so we can verify coverage and estimate your costs before treatment begins.
View FormYour consent for treatment and your acknowledgment of our financial and privacy policies, including HIPAA protections.
View FormYour permission for us to contact you by phone, text, or email about appointment reminders, treatment updates, and billing.
View FormMost new patients complete the full set of forms in ten to fifteen minutes. Having your insurance card and a list of current medications on hand speeds things along.
Each form can be printed at home, filled out by hand, and brought to your appointment, or returned to our front desk ahead of your visit.
List every medication, supplement, and known allergy, even if it seems unrelated to dental care. These details can affect anesthesia choices and medication prescriptions.
Make sure your member ID, group number, and the policyholder's name are entered exactly as they appear on your card to avoid claim delays.
Our authorization form covers consent for treatment and our financial policy. If anything is unclear, call our Glendora office before your appointment and we will explain it in plain terms.
Health changes, new medications, or a new insurance plan? Let our front desk know at your next visit so we can keep your file current.
Paperwork is a small but real part of how your care experience begins. We keep ours straightforward and honest about what we need and why, because the goal is to spend your appointment time on your smile, not on forms. Your information is kept confidential and used only to provide and coordinate your care, in line with HIPAA privacy standards.
Our front desk team reviews every submitted form before your visit so your dentist and hygienist walk in already familiar with your history. That means fewer repeated questions, more time for the conversation that matters, and a visit that respects your schedule.
If this is your first time with us, you may also find it helpful to read more about our practice and meet the people who will be treating you on our Meet the Team page, or browse our insurance and financing information before your appointment.
It is not required, but it saves you time. Patients who complete their forms online before arriving typically spend less time in our waiting room because the front desk already has their information entered and verified. If you prefer, you can also complete them on paper when you check in.
We recommend completing and returning your forms at least 24 to 48 hours before your appointment. This gives our team enough time to verify your insurance benefits and review your medical history before you arrive, so there are no surprises on either end.
You can still complete the rest of your paperwork and fill in insurance details later, either by calling our office or bringing your card to your appointment. We will verify your benefits before treatment either way, so there is flexibility if your card is not nearby.
Yes. All information you provide through our patient forms is treated as confidential and protected under HIPAA. It is used strictly for your dental care, treatment planning, and billing, and is never shared outside of what is necessary to coordinate your care or process insurance claims.
Absolutely. Just let our front desk team know at check-in if your medications, health conditions, address, or insurance have changed since your last visit. Keeping your file current helps us provide safer, more accurate care every time you come in.
No, returning patients generally only need to confirm or update their existing information rather than starting from scratch. We will ask about any changes to your health, medications, or insurance at each visit to keep your chart accurate.
Please bring a photo ID, your insurance card if you have coverage, and a list of current medications if you were not able to add them digitally. If you are transferring records from another dentist, bringing recent X-rays can also help us plan your treatment efficiently.
Glendora Healthy Smiles
Join the Glendora Healthy Smiles family and experience gentle, modern dental care designed around you. Book your visit today - we can't wait to meet you.