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

Feel free to fill out our Online Patient Information form by clicking here.

-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.
Feel free to fill out our Online Consent for Anesthesia Sedation Form form by clicking here.

-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.
Feel free to fill out our Online Consent for Endodontic Surgery Form form by clicking here.