Children's Dentist in Santa Maria, CA 93454 - Dr. Samuel Burg, Dr. Rick Kleinsasser and Dr. Henry Arakaki

Please print, fill out and bring the following forms with you at your next appointment.

First Visit forms
Office Policy/Financial Policy form
New Patient Health form
New Patient History form
Patient Financial Agreement and Consent form

Insurance form
ADA Dental form

Children's Dentist in Santa Maria, CA 93454 - Dr. Samuel Burg, Dr. Rick Kleinsasser, and Dr. Henry Arakaki ~ General Dentists Limited to Children and Teens

Servicing patients in the surrounding cities and areas of Santa Maria, California 93454

Click here to read our Disclaimer. Click here to read our Privacy Policies and Procedures.

Website Designed by