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New Patient Forms

Welcome to Scripps Pediatric Dentistry! In order to make it easy for your first visit with us, you can fill out our new patient form electronically.
If you have any questions you can always call our office at: (858) 693-5677 and we’ll be more than happy to help you out. If you're not able to fill it out before the appointment, then please arrive 10-15 minutes before your child's appointment. Thank you!


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Please download form to your computer and email it to us at: staff@scrippspediatricdentistry.com

We do ask that you fill it out and email the form to us as soon as possible so that we can have everything ready for your appointment.

Please save the file to your computer and open the file with Adobe Reader. If you do not have Adobe reader installed on your computer, you can download it for free at: https://get.adobe.com/reader/

Once the file is open in Adobe Reader, please type in your answers and save file. You don’ need to worry about signing the form, we can do that here at the office.

New Patient Form

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