Modesto Kidz Dental

Patient Forms

Going to the dentist can be an overwhelming experience, especially on your first dental visit. Let us put your concerns and anxieties to rest. Our goal at Modesto Kidz Dental is to make every patient experience as comfortable as possible.

To make your visit as pleasant and brief as possible, there are a few things you should bring with you. Please bring any dental X-rays from the last six months to your first appointment.

With just a few simple forms, we’ll ask for relevant medical history, any medications you might be taking, your dental history, and any dental insurance coverage you may have.

Want to get a head start? Download the new patient forms below.

English Patient Registration Without Insurance

Spanish Patient Registration With Insurance

Spanish Patient Registration Without Insurance

Treatment Without Parent

HIPAA

Location

Bldg B, 2801 Coffee Rd, Modesto, CA 95355

Office Hours

MON - FRI 8:30 am - 5:30 pm

SAT - SUN Closed

Get in Touch

Email: modestokidzdental@gmail.com

Phone: (209) 578-3131