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New Patient Registration Forms
We attempt to see you at your appointed time as much as possible since we believe your time is as valuable as ours. If you would like to save some time, download our New Patient Registration form . Once the form opens, you can use your keyboard and mouse to complete the form, then print and sign the form. Then mail, fax, or bring the forms with you on your next appointment. You are required to read these additional forms due to governmental regulations. The last page of the patient registration form contains an acknowledgement that you have read the required forms.

To view our patient registration forms, please click on the link above. You will need Acrobat Reader, which is a free software program available by clicking the Get Adobe Reader button below.

 

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Richard J. Healy, DDS ,Inc
2151 South College Drive, Suite 201, Santa Maria, CA 93455 Phone: 805-928-3928 : Fax 805-928-2248
www.DrRHealy.com