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* You will receive a call or confirmation email within 24-72 hours after you book your appointment and a call or notification text/email 24-72 hours before the appointment.

PDF DOWNLOAD

If you want to DOWNLOAD the COVID 19 SCREENING form and fill it up please click the link below.

ADA_Patient_Screening_Form _1_

 

FOR NEWARK PATIENT  DOWNLOAD THIS CONSENT FORM

COVID _NEWARK_

 

FOR SAN JOSE PATIENT  DOWNLOAD THIS CONSENT FORM

COVID _SAN JOSE_

 

PLEASE DOWNLOAD also this Dental Treatment Consent FORM

COVID pandemic emergency dental treatment form

 

DOWNLOAD also this COVID 19 porotocol and sign it upon arrival in the office

COVID19 Protocol

FILL UP THIS ONLINE COVID 19 FORM
If you do not like to download the form above, just fill this form and click the submit button. This is an online form and you do not need to print this. Just answer the questions and agree to the terms and conditions stated.
Please upload your ID and Signature below:

NEWARK

NEWARK CA DENTAL OFFICE

Newark Dental Clinic 5910 Thornton Ave. Ste. B Newark, CA 94560 
510-792-4525 
drpmelo@gorgeoussmiledental.com

 

SAN JOSE

SAN JOSE CA DENTAL OFFICE

San Jose Dental Clinic 750 North Capitol Bldg. C Suite 8 San Jose, CA
95133
408-926-2221
drpmelodds@gorgeoussmiledental.com