408-725-1536

Hills Dental Group

Home Patient Information Patient Forms

Welcome and thank you for choosing to become part of the Hills Dental Family.

Here at Hills Dental we are not just happy that you are interested in placing your dental care in our hands - we also assure you of the highest standards of dental treatment. We are known for our experience and expertise as well as the use of the latest technologies to provide you with world class oral care. When you come to us you can be sure of a warm reception, a stress-free experience and the best in dental care. Our focus is always YOU.

We invite you to book an appointment with us and start your journey towards the perfect smile and great overall oral health.

Dr. Rachana Vyas, D.D.S and the Hills Dental Group

To provide the best possible dental and oral healthcare it necessary to have a comprehensive understanding of the patient's overall health. The past and present health conditions that a patients has had and the medications they taking are important factors in determining the proper diagnosis and treatment for many oral conditions. To accurately obtain this information and help expedite the process we encourage patients to download the appropriate health history forms and complete them in advance of their appointment.

New Patient Adult Health History Paperwork

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit. This form includes Health Information and History, Dental and Oral Health Information, Oral Health Risk Factors.

Patient Account Information

This form includes family payment information, dental insurance information, secondary dental insurance information, and medical insurance information.

Notice of Privacy Practices

Please read over and sign our Notice of Privacy Practices, acknowledging our privacy policy and consent for use and disclosure of health information. This form should also be brought to your first appointment.

Click here to print.

New Patient Child Health History Paperwork

If you have a child that you would like to join our practice, and expedite your visit, print this form, fill out this form and have it ready at their first appointment. This form includes Health Information and History, Dental and Oral Health Information, Oral Health Risk Factors.

Patient Account Information

This form includes family payment information, dental insurance information, secondary dental insurance information, and medical insurance information.

Notice of Privacy Practices

Please read over and sign our Notice of Privacy Practices, acknowledging our privacy policy and consent for use and disclosure of health information. This form should also be brought to your first appointment.

Click here to print.

Request for Release of Dental Records

If you are looking to join our practice, this form must be filled out and sent to your prior dental office so we may obtain your records and further your care.

Click here to print.

Call us at 408-725-1536 or email us at info@hillsdentalgroup.com to get you started on straighter, confident smile. Schedule an appointment with us today, and allow us to take care of your teeth.

Office Hours

Monday

: 9:00 AM - 6:00 PM

Tuesday

: 9:00 AM - 6:00 PM

Wednesday

: 9:00 AM - 6:00 PM

Thursday

: Closed

Friday

: 9:00 AM - 6:00 PM

Saturday

: 9:00 AM - 5:00 PM

Sunday

: Closed

 

 

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