The Smile Suite at Towne Square The Dental Practice of Dr. Kenneth R. Klier, D.D.S., Inc.
The Smile Suite at Towne SquareThe Dental Practice ofDr. Kenneth R. Klier, D.D.S., Inc.

Patient Forms

New patient? Please download and fill out the following forms when you come in for your first appointment.

Patient Information Intake Form

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.

Patient_Information_form.pdf
Adobe Acrobat document [80.1 KB]

Patient Medical and Dental History Forms

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.

Medical and Dental History for Adults
Health History for Adult.pdf
Adobe Acrobat document [164.5 KB]
Dental History Form.pdf
Adobe Acrobat document [268.1 KB]
Medical and Dental History for a Minor
Health History for Minor.pdf
Adobe Acrobat document [332.8 KB]

Privacy Notice

Please read over and sign our Notice of Privacy Practices, acknowledging our privacy policy. This form should also be brought to your first appointment.

Privacy Notice
Notice of Privacy Practices.
File [39.0 KB]

The form is saved in Microsoft Word format.  If you don't have MS Office/Word, you can go here to download the "MS Word Viewer" for free:

 

http://www.microsoft.com/en-us/download/details.aspx?id=4

 

Or, if you don't have Microsoft Office and would like a completely free alternative, open source productivity package, try Apache OpenOffice here:

 

http://www.openoffice.org/download/

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The Facts About Fillings

 

Please review this informative brochure published by the Dental Board of California.  This is required to be given to any patient receiving restorative care.

The Facts About Fillings CA.pdf
Adobe Acrobat document [481.5 KB]

Make an Appointment Today!

Call us at: (951) 303-2818

 

The Smile Suite at Towne Square

32605 Temecula Parkway, Suite 213

Temecula, CA 92592

 

Use our contact form to get in touch.

 

            -OR-

Office Hours

Mon.-Fri. 8:30 A.M. to 5:00 P.M.  Other times and Saturdays may be available by arrangement.

 

Outside our regular business hours, please note our emergency care information.

Keep Your Teeth Healthy!

What is the best preventive care for your teeth? Find out how to make your next visit easier and more pleasant.

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