FORMS

Before your appointment please take a moment to print out and complete the forms on this page in order to streamline your child’s visit with Dr. Miller or Dr Trujillo. These forms are available in .PDF format. If you need software to view and print .pdf documents, please visit http://get.adobe.com/reader/ to download a free copy of Adobe Reader.

 

PRIVACY POLICIES

This form is our Privacy Policies.
Download .PDF Form

HEALTH HISTORY AND PATIENT INFORMATION FORM

This is our standard Health History and Patient Information Form used to gather your current and past medical information and medical insurance information. ┬áPlease print out and complete this form and bring it to your child’s dental appointment.
Download .PDF Form

FINANCIAL POLICY AND
CONSENT FORM

This is our standard Patient Financial Policy and Consent for Treatment and Release Form used to allow Jade Miller DDS and /or Gilbert A Trujillo DDS to treat the patient. ┬áPlease print out and complete this form and bring it to your child’s dental appointment.
Download .PDF Form