New Patient Forms



You can save some time at your first office visit by printing these forms, filling them out at home and bringing them in with you. This way, you can take your time as well as make sure your responses are accurate.

Instructions: Click on the name of each form to open it in the Adobe Acrobat Reader. Print it. Complete it in ink. Bring both of them with you to your first appointment.

New Patient Form

Health History Form



If the form does not open in your browser, Click here or on the button below to download the free Adobe Acrobat Reader and follow the instructions to install it.

John Berk, DDS
20652 Redwood Road
Castro Valley, CA 94546
(510) 733-6282
FAX (510) 733-6304

Copyright © 2009 John Berk, DDS
www.JohnBerkDDS.com/forms.htm