Forms

New Patients

If you are a new patient then we are very happy that you decided to contact us and we are excited to meet with you.  For your convenience, the New Patient Packet can be completed and submitted digitally.

You may print, complete, and mail us the forms prior to your first appointment so that we may be prepared in advance of your arrival.

If you are transferring your dental records, including x-rays, please be sure to complete the last page of the New Patient Packet. Once we receive your completed packet, we are happy to submit the “Authorization to Release Dental Records” form to your previous Dentist on your behalf. It is always best practice to submit your completed New Patient Packet to us as soon as possible, this will give your previous dental office the the appropriate amount of time to provide documents, such as x-rays, that are important for your discussions with Dr Benson.

If you have any questions, please feel free to contact us at anytime. Thank you.

 

New Patient Packet

 

Address and Location:

1648 Union St, Suite 202
San Francisco, CA 94123
Phone: (415) 397-4711
Fax: (415) 474-2498
Email: ericbensondds@gmail.com