Alameda Dental Care
Dr. Nelson - Dr. Monroe - Dr. Lee - Dr. Ziadat
Healthy Smiles For A Lifetime
Call: (480)447-1906

New Patient Forms

New Patient Forms for Alameda Dental Care




We appreciate you taking a moment to fill out your new patient forms prior to your first visit with our office. Or, if you prefer, please arrive 10 minutes prior to your scheduled appointment time to fill out the paperwork in our comfortable reception area.


Mention our smile card program and get a $50.00 credit towards any treatment needed.


New Patient Adult Forms 18 Years and Older- Click both links below- you will need both forms!




New Patient Child Forms 17 Years and Younger- Click the single link below

A parent or guardian must complete and sign the documents.  All minors must be accompanied by an adult for their first visit.



For Your Records

The following documents are for your records only.

ADC Office Policy 2010.docx 

ADC HIPAA Policy.docx


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