Regis Atienza DMD and Annabelle Atienza DMD Dentistry for Children and Adults 1240 Robinhood Dr. Suite C Stockton CA 95207 (209) 594-1119 (209) 405-3190 text Monday to Thursday 8:30 am to 6:30 pm YES, WE ARE NOW OPEN !
Regis Atienza DMD  and  Annabelle Atienza DMD  Dentistry for Children and Adults    1240 Robinhood Dr. Suite C      Stockton CA 95207     (209) 594-1119     (209) 405-3190 textMonday to Thursday   8:30 am to 6:30 pmYES, WE ARE NOW OPEN ! 

Patient Forms

New patient? Please download and fill out the following forms when you come in for your first appointment.

Patient Medical History Form

This form is mandatory for new patients. To expedite your visit, please print this form, fill it out and bring it with you for your first visit.

Adult Registration Form page 1
Adult Registration Form pg 1.png
Portable network image format [246.2 KB]
Adult Registration Form page 2
Adult Registration Form pg2.png
Portable network image format [422.0 KB]
Child Registration Form
Child Registration Form.png
Portable network image format [3.1 MB]
Handle Me With Care Form for adult and child
Handle me with care.png
Portable network image format [140.9 KB]

Privacy Notice

Please read over and sign our Notice of Privacy Practices, acknowledging our privacy policy. This form should also be brought to your first appointment.

Download
Privacy Notice
New file download

Make an Appointment

Call: (209) 594-1119

Fax: (209) 594-1740

email:

atienzadental@

atienzafamilydental.com

Text: (209)405-3190

 

1240 Robinhood Drive 

Suite C

Stockton Ca 95207

 

 

Print Print | Sitemap
© Atienza Family Dental

This website was created using 1&1 IONOS MyWebsite.