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Call (831) 884-5069

Patient Forms

Patient Forms:

REGISTRATION FORM

 

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.

Technical Note:

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:

 

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.
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

 

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.
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Office Locations

  • Monterey
  • 24551 Silver Cloud Court, Suite 102
  • Monterey, California
  • 93940
  • Map & Directions
  • Call: (831) 884-5069
  • Salinas
  • 1124 Pajaro Street
  • Salinas, CA
  • 93901
  • Map & Directions
  • Call: 8317573021