Forms

In Santa Fe, New Mexico

Robert L. Wartell, DDS
Kristine Berg Ali, DMD
Sandraluz Gonzales, RDH

Forms to Complete

There are different forms for you to complete, depending on your reasons for coming to our office. After the forms are completed, and we have the appropriate referral letter from your referring doctor, and records and x-rays from the appropriate physicians and dentists, we will schedule your appointment.

As you know, all parts of your body are inter-related. Anything we do in treating you may have an effect in other parts of your body. That's one reason we ask so many questions. Problems in certain body parts or systems may cause problems in your mouth, jaws, or head. That's another reason we ask so many questions.

Even though there are sooooo many questions, there are not too many questions. Please be patient and complete everything we ask of you. Remember, as your parents told you, "it's for your own good."

If you are coming for an evaluation of your teeth and gums:

Form 1 - complete this online

Form 5 - print, complete, and return it to us. You may return form 5 by fax, by mail, or in person. It requires your signature.

If you are coming for diagnosis and treatment of jaw, face, or head pain:

Form 1 - complete this online

Form 2 - complete this online

Form 3 - complete this online

Form 5 - download, print, complete, and return it to us. You may return Form 5 by fax, by mail, or in person. It requires your signature.

If you are coming for treatment of sleep apnea:

Form 1 - complete this online

Form 4 - complete this online

Form 5 - download, print, complete, and return it to us. You may return Form 5 by fax, by mail, or in person. It requires your signature.

We enjoy answering your questions. For more information,
please call us at505-474-4644

Center For Dental Medicine • 2019 Galisteo St. • J2 • Santa Fe, NM 87505

(Behind Los Alamos National Bank, St. Michael's & Galisteo) Map

You may contact us by:
phone: 505-474-4644
Email Us
postal: 2019 Galisteo St., J2, Santa Fe, NM 87505