Dr. Derrick M. Chan, DDS  
   
x x
Appointments x
Billing x
Forms x
x x
Home x
Contact Us x
Library x
x x
x x
  x

 

First Appointment - in order to speed up you first appointment please complete both Registration and Medical History forms and fax them to 415.221.9444 - This way you'll be all set up in our system before you ever come in the door.

Annual Update - to be sure that we are aware of any changes in your health care, we ask that you complete the Medical History form annually, you can fax it to 415.221.9444 or bring it with you to your next appointment.

NOTE: If you have been recently been diagnosed with any type of heart condition, systemic infection, or plan to have any type of surgery, please call our office at 415.221.5200 so we can verify with your doctor if you need pre-treatment medications.

Acknowledgement of Receipt

Agreement for Professional Services

Notice of Privacy Practices

Patient Registration Form

Patient Medical History Form

 

 

 

 

 

Home | Appointments & Info | Contact Us | Dental Library | Online Tour | Our Staff

Privacy | Disclaimer
Copyright © 1996-2008 Dr. Derrick M. Chan, DDS