Patients Forms

Patient Dental Forms

Your first visit establishes a vital foundation for our relationship with you. During the first visit, we make sure to give you plenty of time to get to know Dr. Max Arocha and Dr. Karla Jaquez. There's also background information about our committed Doctors and dental procedures. You can save about 15 minutes at your first visit by printing out and completing the patient forms below.

Mission Statement

" We are interested in building strong lifelong relationship one patient at the time"

At our plantation dental office, we will do everything possible to ensure you a pleasant and relax visit. Our passionate dentists enjoy taking time to listen, understand you, and explain all procedures to your satisfaction. We make every effort to treat our patients just like our own family. Feel free to come into our office and look around, meet our staff and the Doctors. Decide for yourself if we can meet your needs. We look forward to meeting you.

New-Patient Forms

Please click, print out, complete and sign form 1,2 & 3 below so we can expedite your first dental visit upon arrival:

  1. New Patient Medical History Form
  2. New Patient Dental Treatment Informed Consent Form
  3. New Patient Hippa Form
  4. Notice of Privacy Practice - (this is a copy of your information)

Sedation Consent Forms

Please click, review and sign on the form below:

In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.


What To Expect

Being well-prepared for your dental appointment will ensure that the doctor has all of the needed information to provide the best possible dental care for you. It also helps relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. Also, take some time to review our Our Doctors page and familiarize yourself with the doctor(s). We look forward to your dental visit with us.


Driving Directions

We are conveniently located at the northwest corner of Peters Rd and South University Drive. We are behind Wells Fargo bank and next to the new Publix (where old Alberson used to be). Parking is available in front of our dental office.

Office Hours
Monday:9:00 AM - 5:00 PM
Tuesday:9:00 AM - 5:00 PM
Wednesday:9:00 AM - 5:00 PM
Thursday:9:00 AM - 5:00 PM
Friday:9:00 AM - 2:00 PM
Saturday:Closed
Sunday:Closed

Contact Us