Patient Forms

Are you tired of wrangling the littles as you struggle to fill out paperwork? We get you. Almaden Valley Surfside Kids Dental offers convenient online patient forms for pediatric dentistry and orthodontic care in Almaden Valley and San Jose, California. We invite you to fill out your forms before you meet with our orthodontist or pediatric dentist so you can be ready to breeze into your visit with Dr. Derick Phan, Dr. Keerthi Golla or Dr. Josh Lin when you arrive at our office. Call 408-770-9383 if you have any questions.

Child Health History Adult Health History Automatic Credit Card Authorization

Historia de Salud del Niño (Child History) Historia de Salud de Adulto (Adult History) Cuestionario Complementario de Salud (Credit Card Authorization)

Patient Reviews

Dr. Phan is amazing! His support team is just amazing! Way above and beyond rock stars. Super nice make you feel welcome give an awesome experience.

— Elisa S.

I would recommend Surfside to anyone with young children. Very friendly staff and just an all around good experience.

— Enn M.

Huge thank you to the staff at surf side kids! The staff is very friendly and truly cares about their clients.

— Sydney A.

Great doctors and dental assistants. Kiddos used to love the games in the waiting room pre-pandemic and they also get cool little prizes after a visit!

— Elizabeth N.

Our 12 year-old son just recently started going to Surfside and loves it! He said one of his favorite things is that everyone is super nice and makes him feel comfortable.

— John Eza

Contact Us

408-770-9383

6942 Almaden Expressway
San Jose, CA 95120

DayHours

Monday8:30 a.m. - 5:00 p.m.

Tuesday8:30 a.m. - 5:00 p.m.

Wednesday8:30 a.m. - 5:00 p.m.

Thursday8:30 a.m. - 5:00 p.m.

Friday8:30 a.m. - 5:00 p.m.

SaturdayClosed

SundayClosed

Patient Forms

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