Pueblo Dental Center "Catering to Cowards"
1400 W. Valencia Suite 100 Hours: Monday - Friday 8 am to 5 pm Tucson AZ 85746 (520)746-1068 FAX: (520)573-1887
Staff
Forms
New Patient Forms
English
- New Patient Information
- Medical History
- Office Policy
- Privacy Policy Signature Sheet
- Privacy Policy Page 1
- Privacy Policy Page 2
Spanish
- Informacion Del Paciente
- Informacion Dental/Medica
- Reglamento De La Oficina
- Hoja Para Firmar Sobre Los Reglamentos De Privacidad
- Reglamentos De Privacidad 1
- Reglamentos De Privacidad 2
Please fill out and sign pages 1-4 and bring them with you to your appointment.
If you would like a copy of your x-rays or records, we require that you sign a release of records form. Please fill out this form and send it back to us by mail or fax.
If a child under 18 comes in for an appointment, they must be accompanied by a legal guardian. If anyone other than the legal guardian is to bring thm, a legal document must be signed stating that they can be brought by someone other than their guardian. This form must also be notarized.