New Patient Forms

When you arrive at our office for your first visit, you will be greeted by our wonderful receptionist, who will assist you in checking in and notifying our treatment coordinator and staff of your arrival. Then, after a brief tour of our office, we will take a complimentary panoramic X-ray and diagnostic photographs of you or your child. Dr. Greenspan will then meet with you in our consultation room where you will learn all the options and determine if treatment is needed now or later, or perhaps, not at all. For your convenience, we have new patient forms available to download on our Web site that you may fill out and have ready with you for your visit. If you have insurance coverage, it would also be ideal to have your necessary paperwork ready with you, so we may assist you in receiving your benefits.

As always, if you have any questions at all, please contact Dr. Greenspan or any of our friendly staff, and we will be happy to assist you.

Please fill out this form prior to your first visit. You may submit your form online; print, fill out, and bring in the completed form or fax it to (858) 755-8806.

New Patient Information Form - Submit Online

New Patient Information Form - Print

You may have a PDF Preview Browser Plug-in either installed or enabled on your system. PDF Preview Browser Plug-ins DO NOT contain all the necessary features that are required to submit forms online. If you would like to submit your forms online please follow the instructions below, these links may help you enable the Official Adobe Acrobat Reader for your browser.

1) Get the latest official release of Adobe Acrobat Reader

2)Enable Adobe Reader for Chrome

2) When asked make sure you enable Adobe Acrobat as your default PDF viewer
3) Make sure that you are running Safari in 32 bit mode

You DO NOT have Adobe Acrobat Reader installed and/or enabled, if you would like to accurately view, print or fill out our forms online please download Adobe Acrobat Reader

1)Get the latest official release of Adobe Acrobat Reader

If cannot submit the forms on line or if you do not want to download Adobe Acrobat Reader, please feel free to print our forms below, fill them out, and bring them into our office.

If you are using Safari for Mac or Google Chrome you will need to download, print and bring these forms with you to your first appointment. These browsers are not compatible with Adobe Reader and will not submit your forms to our office properly. We apologize for this inconvenience.

New Patient Information Form - Print

These forms require Adobe Acrobat Reader.
Click the Adobe logo to download.

Attention Google Chrome, iPad and Mac OSX Safari browser users: Please make sure you are using Adobe Reader to open and submit the New Patient Online Forms and not the browsers built-in Preview mode. Using Preview mode will not submit the forms successfully. Please be aware the forms may not be compatible with your computer to submit online. Please open the forms and print out. Complete the forms and bring into the office. If you are not able to print the forms, the forms will be available in the office for you to complete before your appointment.