At EccoDental, we want your dental experience to be as enjoyable as possible. We invite you to fill out our patient forms before your first appointment to save you some time during your first visit with our dentist in Glendora, California. We have provided our patient forms below. If you have any questions about the forms, or if you are ready to schedule your next appointment with Dr. German G. Jaquez, please call a member of our team at 626-771-0064. We are happy to assist you.

In order to submit the online forms, you must use Google Chrome web browser. Click here to download

Health History Form

New Patient Downloadable PDF (Fill it out on your computer and print, or print it to fill out by hand.)