1260 Healdsburg Ave, Ste #101,
Healdsburg, CA 95448
707-433-5052

Patient Resources

Healdsburg Dentist


For your convenience, our New Patient Forms are available for download here in Adobe Acrobat PDF format. The Adobe Acrobat Reader is FREE and can be downloaded by clicking on the icon below.

Please print and complete these forms at home before your first appointment. If you need assistance with downloading or printing these forms, please contact our office.

Download Free Adobe Acrobat Reader Now

Welcome Form Medical History Form Dental Materials Fact Sheet Privacy Notice Spanish - Welcome Form Aviso do Las Pràcticas de Privacidad Historial Medico
Robert Leach, DDS
Raafia Mazhar, DDS
Jesse Whitely, DDS

Appointment Request

Appointment Date*
Your Preferred Time
Your Name*
Email Address*
Your Contact Number*
()
Other Specific Requests/Comments*
Enter verification code*
Reload Image