Julianne K. Yoshioka-Wong, DDS
Call: (408)374-2745

New Patient Registration Forms

For your convenience, our New Patient Registration Forms can be downloaded to your computer and then printed for you to complete. Each 5 page packet consists of:

                                    A. Registration forms (2 pages)

                                    B. Dental history form

                                    C. Health history form

                                    D. HIPAA/Authorization for submission of claims and assignments of benefits form 

Please be sure to bring all of these completed forms as well as your dental insurance information to your first appointment. We look forward to meeting you!

You may download the new patient registration packets here:

1. New Patient Registration Form Packet - adult

2. New Patient Registration Form Packet - child


This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.