Santa Cruz Dentist - Christopher C. Keys, D.D.S.

There are some forms we will ask you to fill out when you arrive at the office for dental treatments. They are posted here as a convenience for patients who might prefer to read and/or fill them out ahead of time. Each form is a PDF file that can be viewed online, downloaded and printed.

Patient Contact, History and Insurance

• P1 - Patient Information Form
• P2 - Spouse or Responsible Party Information Form
• P3 - Primary Dental Insurance Form
• P4 - Secondary Dental Insurance Form
• P5 - Dental History Form
• P6 - Dental History Continued Form
• P7 - Consent for Treatment Form
• P8 - Acknowledgement of Receipt of Notification of Privacy Practices

Health Insurance Portability and Accountability Act

• HIPAA Notification of Privacy Practices