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.

New Patient Paper Form (Patient Registration + Health History)

(Click above to download the form)

Download
New Patient Paper Form (Patient Registration + Health History) - Spanish

(Click above to download the form)

Download
New Patient Online Submission 1/2 (Patient Registration)
New Patient Online Submission 2/2 (Health History)
Notice of Privacy Practices Form

Old Patient Paper Form English Download: https://raphadentalllc.com/wp-content/uploads/2023/03/Patient-Form-Full.pdf _blank
Old Patient Paper Form Spanish Download: https://raphadentalllc.com/wp-content/uploads/2023/03/New-Patient-Packet-Spanish-full.pdf _blank

Download
Office Policy Form

Old Patient Online Submission 1: https://www.raphadentalllc.com/online-patient-registration/
Old Patient Online Submission 2: https://www.raphadentalllc.com/health-history/

Download

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