Patient Forms

Patient Forms

Please use the button below to take you to a secure site where you can enter all the necessary information prior to the arrival for your appointment. This will greatly speed up the registration process for your next visit. Thank you and please call our office if you have any questions at all.

If you are a New Patient please fill out both form 1 (new patient registration) and form 2 (medical history).

If you are an Existing Patient please fill out and updated medical history form only.

Online Form

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.

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20353 Lake Chabot RdCastro Valley, CA 94546Get Directions510 582-2133


Castro Valley, California Dentist, Dr. Michael Terry is dedicated to cosmetic dentistry such as Exams, Teeth Whitening, Veneers and more.

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