Call us today at (925) 706-8688!

1. Fill out the appropriate New Patient Form below

PEDIATRIC NEW PATIENT FORM

PEDIATRIC RECARE FORM

AUTHORIZATION FOR THIRD PARTY CONSENT FOR TREATMENT OF A MINOR

2. Review Health and Privacy Reference

HIPAA

3. Dental Materials Fact Sheet

Dental Materials

4. Professional Referral Form

For local dental offices,

Please email or fax referral to KidsDentalWorld@gmail.com or (925) 706-8588

DENTAL OFFICE REFERRAL FORM

Kids Dental World

4045 Lone Tree Way Suite A

Antioch, CA 94531

Phone (925) 706-8688

kidsdentalworld@gmail.com

Fill out the contact form below and we will respond as soon as possible. By filling out this form, I consent to receive text messages, emails, and/or phone calls from this office.