New patients will need to complete the Registration Form and bring them to the appointment. Please answer ALL questions and sign where indicated.
If it has been over six (6) months since you were seen in our office, complete the Registration Form and bring all pages to the appointment. Please answer ALL questions and sign where indicated.
Thank you for your cooperation!
The security and privacy of your personal data is one of our primary concerns.
We have taken every precaution to protect your privacy.
You will need Adobe Acrobat Reader to view our Registration Form. Please download the free Acrobat Reader from Adobe’s website if it is not already installed on your system.
Medical Release Form
Printable FormAuthorization to Release Medical Record Information
If you wish us to release your medical records to you or another doctor, please fill out the following form and mail or fax it to:
Chad N. Allen, D.D.S.
Robert M. Mraule, D.D.S., M.D
Oral and Maxillofacial Surgery
24551 Silver Cloud Court, Suite 102
Monterey, CA 93940
Fax: (831) 884-5178
1124 Pajaro Street
Salinas, CA 93901
Fax: (831) 757-5833