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Diana – Patient Coordinator
Feel free to call our office. We’ll be happy to answer any questions or walk you through the pre-approval process.
Diana - (925) 753-5810
 

Patient Forms

To expedite your initial root canal therapy visit , download and complete our Patient History, Consent and HIPAA forms in the comfort of your home.

  1. Patient History Form (352 KB)
  2. Consent Form (329 KB)
  3. HIPAA Form (56 KB)
  4. Privacy Notice (124 KB)
  5. Download the above files as one zipped file. (555 KB)
  

 

East County Endodontics | Root Canal Specialists | Located in Antioch | Serving Patients Across East County

Antioch Office Phone: (925) 753-5810 / Email: More Info