Our Office Our Staff About the Dentist Our Services Appointment & Hours Map & Directions Financial Arrangements New Patient Registration---
  Tuesday September 07. 2010   Acknowledgment of Receipt Dental Materials Fact Sheet Health History Notice of Privacy Practices





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   Our Office
Join E-mail
E-mail Reminder
   Our Staff
   About the Dentist
Ask The Dentist
   Our Services
   Appointment & Hours
   Map & Directions
   Financial Arrangements
Financial Arrangements Form
   New Patient Registration
Acknowledgment of Receipt
Dental Materials Fact Sheet
Health History
Notice of Privacy Practices

 
 
Thank you for taking the time to fill out our New Patient Registration.  Please allow 15 to 20 minutes to read and fill out the forms listed below.  We hope this will save you time and add to your experience at our office.
 
Please print and fill out a copy of the Health History Form to bring to the office upon your first visit.  Also, please read our Notice of Privacy Practices and the Dental Materials Fact Sheet, then print and sign the 'Acknowledgment' page verifying that you have read these notices, and bring this to the office as well. Again, we thank you and are excited to see you soon.
 
 
Health History Form (fill out and bring to the office)
 
Notice of Privacy Practices

 
Acknowledgment of Receipt of Notices (sign and bring to the office)


Lastly, please print and fill out a copy of this Financial Arrangements form to bring to the office.

Financial Arrangements (fill out and bring to the office)


 



 
Dr. John M. Moffat, D.D.S.
23111 Ventura Blvd., #102
Woodland Hills, CA 91364
Phone: (818) 225-0041
johnmoffatdds@sbcglobal.net

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