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Bernard Rust, DDS, MAGD
Changing lives one smile at a time!
Call: (210) 499-4746

Patient Forms

Lifetime Dental at San Pedro Patient Forms - Download, Print & Complete

If you are a new patient to our office the attached files contain our new patient forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Please print all four links, there are 6 forms total.  Thank you and please call our office if you have any questions.

Patient Registration   

Medical History

Total Health Checklist

Insurance Policy.pdf

Financial Policy

Please go to the Notice of Privacy page and read the Privacy Notice before signing the release form below.

HIPAA Form Receipt of Privacy Practices and Release of Information.pdf

Testimonials

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