Saratoga Healthy Smiles
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New Patients

The following forms are required for new patients at Dr. Irina's office. You may print and fill out the following forms in order to have a quick, expedited first visit at our office.

Note: In order to view these forms, it is recommended you have Adobe Reader installed on your computer. Click here to download the latest version.

Click the download button to open the forms in a printable view.

Children

• Appointment Policy
• Medical History
• Billings Facts
• Receipt of Notice
• Responsibility Party
Download Now

Adults

• Appointment Policy
• Billings Facts
• Receipt of Notice
• Patient Information and Medical History
Download Now
Saratoga Healthy Smiles (Irina Vaynshteyn, DDS)
1888 Saratoga Ave, Suite 102. 
San Jose, CA 95129
(408) 899-4820

  • Home
  • About
    • Meet Dr. Irina
    • Reviews
  • Services
    • Schedule an Appointment
    • New Patients
    • What We Offer
  • Contact