(209) 578-3184

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.

These documents are in Adobe PDF format. If you’re unable to read PDF files, please  download free Adobe Acrobat Reader here.

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Our Happy Patients

"I have brought my oldest here for almost 3 years and I plan to bring my other child as well because of how well each appointment has gone. Staff and Dentist are both very kind. I love the kid friendly atmosphere they have built. I would recommend to anyone I know in need of a dentist for kids."

Mari G Mari G.

"Th staff made my kids experience INCREDIBLE. Play area in waiting room with little bouncy ball dispenser made our wait a breeze! Once we went back staff was so friendly and there was even a tv screen on the ceiling above the chair. Trolls was on, big brownie points from my 4 yr old . And after The apt they gave each of my kiddos a super cute little tooth brush set and a token for another bouncy ball! Great place for the kiddos. Highly recommend ."

Tellisa J Tellisa J.

"Bright and clean play area in the waiting room. Polite and friendly staff at reception as well as in the back. They were great with my kids (including the baby). Clean and fun themed exam rooms with kids movies playing to keep the kiddies entertained. Fun Tooth brush kits were given to them when they were done as well as tokens so the kids could pick out there own prize from a coin op dispenser."

Elizabeth S Elizabeth S.
We’re here to help your child keep the perfect smile!
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