Patient Forms

Secure Online Patient Form

Complete and update your patient forms from the comfort of your home and ensure that we get the most up-to-date information. Everything you submit on the online form is encrypted for your protection and goes straight to Pristine Family Dentistry.

Secure Online Patient Form in Citrus Heights, CA
Printable Patient Form Form in Citrus Heights, CA

Printable Patient Form

The printable form is in a PDF format and requires a PDF reader such as Adobe Acrobat (Windows) or Apple Preview (Macintosh).

Request a Consultation!

Pristine Family Dentistry
8035 Madison Avenue, Suite F2 Citrus Heights CA 95610
1-916-967-0358 USD Cash, Check, MasterCard, Visa, American Express, Discover, Most Dental Insurance Plans, CareCredit, Lending Club Patient Solutions, Prosper Healthcare Lending
Nathalie Selvanathan Doctor
Karthik Raghuraman Doctor