Dr. Shelby Smith
Kids Love Us, Parents Trust Us.

New Patient Forms

Save time waiting in our office by filling out necessary forms online. Feel free to give us a call if you have any questions.

New Patient Forms

COVID 19 Prescreening Form

General Anesthesia Paperwork

Please fill out and return the following paperwork to our office at least one business day prior to your scheduled anesthesia date.

Oral Sedation Paperwork

Please fill out and return the following paperwork to our office at least one business day prior to your scheduled anesthesia date.

Professional Referral Form

Referral form to be printed and filled out by local dental offices.

Please email or fax referral to drshelby.scheduling@gmail.com or 925-755-5003.

Dental Records Release

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (925) 755-5115
View the ADA Accessibility Statement
We apologize that we
are temporarily unable to accept 
new patients while our older patients age out.

Please check back with us soon for updates
to our new patient availability.