Periodontics Patient Forms

Accepting New Patients in Santa Cruz, San Jose, Morgan Hill CA

Please assist us at the time of your initial visit to the office by providing the following information:

New Patient Forms

  • Your referral slip (if you have one) and x-rays from your referring dentist (if you are being referred)
  • A list of medications you are currently taking
  • If you have dental insurance, please bring any forms or insurance cards with you to the appointment.
  • Contact information of your physician(s)

If you are not a new patient, you may find our returning patient forms below!

Returning Patients

Please Click Here to Access Your Online Account

Patient Account Access

Contact Our San Jose Office


Please contact the office of Periodontist Dr. Fabrice J. Gallez in San Jose, CA by completing the form below. (Or, call our office at 408-356-9366.) This contact form should not be utilized for communicating private health information.
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