Patient Forms

by Fremont Dentist Jaspreet Harika DDS.

A very warm greeting to you, at Bay Smile Dental

All new patients are requested to complete the registration form & Medical History Form, using secure web link below.

Click Here to complete COVID-19 screening form (To be completed by all patients, on the day of the appointment)

Click Here to fill and Submit Registration Form

Click Here to fill and Submit Medical History Form

Please complete separate forms for each family member.

The forms do not need to be printed. Once you have completed the information, simply click “Submit” button. If you are using a mobile phone please make sure the “submit” button is visible on the screen. In case you do not see the submit button on your mobile device, please use a larger portable device or a desktop computer.

We are Looking forward to see you at our office. Please call us at 510.284.2511 for questions.

In case you have not setup an appointment yet, Click Here to Book your appointment.

Fremont Dentist Dr. Jaspreet Harika is an experienced dentist serving Fremont, Union City, Hayward, Milpitas, Newark CA and surrounding areas. Serving zipcode 94536, 94538, 94539, 94541, 94542, 94555, 94560, 94587, 95035, and beyond.