CHILD NEW PATIENT FORM

1PATIENT INFORMATION
2PARENT(S) / GUARDIAN(S)
3PRIMARY DENTAL INSURANCE
4ADDITIONAL DENTAL INSURANCE
5MEDICAL HISTORY
6DENTAL HISTORY
PATIENT INFORMATION
“Our family loves this office! My son feels that they are ‘careful, gentle, speedy and kind.’ I appreciate how organized and friendly their staff is. From our first visit, they have put my children at ease. I especially appreciate that they take the time to explain each step of the process to both me and my children. Their rewards cards are an extra bonus and motivator for my kids.”
S.B., Parent
“This office is one of the best I have experienced. I am truly amazed at the innovative ways they’ve come up with to incentivize the kids to be responsible in their oral hygiene. If you are anywhere close to the Bay Area, I would highly recommend this office (definitely worth a drive!).”

T.B., Father
“What I observed and appreciated was that Dr. Ikeda and her staff took the time to analyze each of my sons’ jaws and teeth, kept them very comfortable and happy as they did, and they warmly explained TO THEM what they were seeing in a way that was easy for them to understand… After our initial meetings with Dr. Ikeda, I knew that we were in skilled and caring hands.”
A.B., Parent
“From my child: ‘I think this is a really good place because I like all the people who work there. When I ask questions they actually explain to me what is going on. I enjoy being there and I think it’s the best orthodontist for me!’ Great staff, very clean facilities. Everyone is helpful and answers all questions, which is very comforting for parents like me who are new to orthodontics. Highly recommend!”
S.S., Parent
“There is an art to creating the ‘perfect smile’ that is different for each patient. What works on one patient does not work on all, and they approach each patient as a unique individual and thoughtfully craft a treatment program designed to minimize discomfort. They do amazing work.”
J.M., Parent

CONTACT OUR TEAM

OFFICE HOURS

  • Monday – Thursday:
    7:30 am – 4:20 pm

    Friday:
    7:30 am – 10:50 am

Hillside View Orthodontics rewards card