Patient Forms

Click on the form below. All forms are in the pdf format, and fillable using Adobe Reader. You may submit the forms using one of the following:

  • Send us the completed form as an attachment to your email, to info@clovisendo.com, OR
  • Send us the completed form via fax to 559-322-2056, OR
  • Print out the form and bring with you to your next appointment.

-Patient Information Form

-Consent for Anesthesia Sedation Form

We offer oral sedation. Please let us know if you are interested this option when scheduling your treatment with our office.

-Consent for Endodontic Surgery Form

Whenever we perform an apicoectomy (a surgery for a tooth that has been treated with a root canal before), we ask patients to sign a consent for endodontic surgery form.