Mark R. Maher, DDS
Walnut Creek, CA

New Patient Forms

The links below transmit via a secure connection to our local system. 

  • New patient link comprises registration/insurance, medical history, HIPAA/privacy policy, and financial policy.  Please fill each form out as completely as possible and then advance to the next form.  Each form is filled out and then submitted all together at the end.
  • The forms can be completed on mobile devices or desktop/laptops, however, the mobile format for the health history requires a lot of scrolling, a desktop/laptop is a bit easier.
  • For the medical history please be sure to click "No" on conditions that do NOT apply to you as well as marking the conditions that do apply.  
  • If you are an existing patient in our system and are just doing an annual update please just use the "update" link.

 

If you have difficulty using our website, please email us or call us at (925) 935-1159
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