Patient Forms

Patient Forms

 

The first visit to our office is designed to get you better acquainted with all we offer as well as introduce you to Our Doctor and our caring staff. We encourage questions and do our best to always deliver quality care.

Please take a moment prior to your scheduled appointment to download our patient forms. We ask that you complete the forms and bring them with you to your appointment so we may better assist you in a timely manner. Thank you for your confidence in our office, we look forward to assisting you with all your dental needs.

Patient Insurance Information

HIPAA Privacy Act

Patient Dental History

Patient Health History

 

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

 

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Quality professional team members that pride ourselves in furthering education to ensure you get the quality care you deserve.

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160 E Artesia St Ste 125Pomona, California 91767-2920Get Directions(909) 622-1261

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We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.

2024 Jeffrey B. Thomas, D.D.S.