Before your first appointment, we ask that you download and fill out the appropriate forms packet below.

Using a Mobile Device?
You must have Adobe Fill & Sign or a similar app installed in order to be able to fill out the forms on your device. You can download the Android version here and the iOS version here.

General Dental Services Form
Biological Dental Services Form

Once you’ve completed the forms, please send them to us at least one week before your first appointment:

Post: PO Box 128, Escalon, CA 95320
Fax: 209-838-2460

Troubleshooting Info
If you’re not able to fill out the form online, download it to your computer, then open the PDF and fill it out. If you run into problems, contact our webmaster directly.

Copyright ©. Gary M. Verigin, D.D.S., inc. All Rights Reserved. California State Licensed General Dentist.
Disclaimer: We make no claim of providing superior services, nor do we guarantee any specific outcomes from the services we provide.