New Patient Forms
Save time by completing your forms online before your appointment.
To expedite your check-in process and make your first visit as smooth as possible, we invite you to complete your new patient registration securely online through our patient portal.
Opens our secure patient portal in a new tab.
Scan to open on your phone
Before You Start
To complete forms online, you must already have an appointment scheduled with us. Enter the phone number we have on file for you, so your forms are linked to your patient record.
Completing your forms ahead of time will ensure a faster, more streamlined experience when you arrive at our office. Wondering what else to expect? See our visit guide.
No Appointment Yet?
Call our office or request an appointment online. Once your visit is scheduled, you can complete these forms.
Our team will follow up on online requests. In pain? Please call us.
Need Help or Another Format?
If the online portal is difficult to use, call (707) 523-3636 or email winecountryrootcanal@gmail.com. We can help you access the forms in another format. Please do not email private medical information.