New Patient Forms

We are happy to offer our patient forms online. Please feel free to print and fill them out at your convenience before your visit.

New Patient Registration

Please download, print and complete this form before your first dental appointment.
Click here to download (66 KB)

Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information.
Click here to download (229 KB)

HIPAA Form

Please download, print and complete this form before your first dental appointment. This form confirms that you read our Notice of Privacy Practices.
Click here to download (295 KB)

 
If you are unable to view the pdf files, please click on the icon below to download and install Adobe Reader:

Request Appointment

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    Thursday
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  • Morning
    Afternoon
    Early Evening

Our Office

Costa Rica Dental Clinic Lab

Curridabat Diagonal Esquina Noreste Plaza Jose Maria Zeledon
San Jose, Costa Rica
Map & Directions
clinicapeji@gmail.com
 
Local Phone:
506 2281-1405
 

Office Hours:
Monday8:00am-5:00pm
Tuesday 8:00am-5:00pm
Wednesday8:00am-5:00pm
Thursday8:00am-5:00pm
Friday 8:00am-5:00pm
Saturday By Appointment Only
Sunday By Appointment Only