top of page
015A2238.jpg

New Patient Paperwork

Welcome to our practice! To help make your child’s first visit smooth and easy, please complete the appropriate New Patient Forms before your appointment.

Choose the correct form below based on your child’s age. Once completed, you can either email the forms, fax them, or bring them with you at the time of your appointment.

We look forward to meeting your family and helping your child feel comfortable and confident at the dentist!

Tel: (415) 448-8120
Fax: (415) 448-8121

email: info@DrDorostkar.com

Medical History Forms for ages 2 and under

Medical History Forms for ages 3+

If your child has seen a dentist before, please fill out the form below to transfer records to our office.

Greenbrae

1300 South Eliseo Drive, Suite 100

Greenbrae, CA 94904

Mill Valley

650 E. Blithedale Ave, Suite C

Mill Valley, CA 94941

  • Instagram
  • Facebook
  • Youtube
​​​Contact Us

Tel: (415) 448-8120
Fax: (415) 448-8121

email: info@DrDorostkar.com

bottom of page