At the office of Dr. Jesus M. Rodriguez, D.D.S., we offer patient forms online so you can complete them in the convenience of your own home or office. Fax us your printed and completed forms or you may bring them during your visit.

New Patient RegistrationDownload or Submit Online

Medical HistoryDownload or Submit Online

HIPPA Consent FormDownload or Submit Online

If you do not have AdobeReader® installed on your computer, Click Here to download.