New Patient Forms

Please fill out New Patient Paper Form (English or Spanish) after printing it out on your printer and bring it to us.

Or you can click and fill out 2 New Patient Online Submissions through our website instead, forms will be delivered to us by Online.

(New Patient Forms are divided into 2 Online Submissions to make it easier for you to fill out)

If you don’t understand how to do this, that’s fine. Please arrive 20 minutes earlier than your appointment time to fill out paperwork at the office.

We appreciate your interest in Rapha Dental and look forward to meeting with you soon.

Thank you.

Online Submission Part 1 - Registration

Online Submission Part 2 - Heath History

Printable New Patient Form (Registration + Health History) in English

(Click above to download the form)

Printable New Patient Form (Registration + Health History) in Spanish

(Click above to download the form)

HIPAA Notice of Privacy Practices Update (English)

(Click above to download the form)

HIPAA Notice of Privacy Practices Update (Spanish)

(Click above to download the form)

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