2655 Cleveland Avenue, Santa Rosa, CA 95403 • (707) 542-1026

Patient Forms

Help us get to know you!
Complete our forms by mail
Please contact our office so Roxanne, Nancy or Sherry can mail you Patient Information and Financial Guidelines forms for you to complete and bring to your first appointment. If you are unable to complete the forms before your appointment, please arrive 10 minutes early and you may complete them in our office.
Complete our forms online
You can complete the forms online before your appointment. Our online forms are safe to use and when completed they will be securely delivered to our office.

Click to complete forms online

We look forward to meeting you at your first appointment.

“Yesterday I had a long overdue appointment with Dr Phillips. It has been several years since I last was in and my mouth is a mess -- I fully expected to get scolded for neglecting my dental care but in my defense I've been dealing with several other medical issues. Well, my experience yesterday was the MOST POSITIVE experience I have ever had in a dental office. Efficient, friendly, professional -- and most of all I felt that I was received the best dental care possible. Five stars are not enough to convey my thanks and gratitude for Dr Phillips' office and his wonderful staff. I now have a treatment plan in place and am anxious to move forward with restoration. Thank you all, thank you!”

— Darryl Fenley April 8th, 2016