Richard L. Daffurn D.D.S.

181 Andrieux St. Suite 104
Sonoma, CA. 95476
Tues. Wed. Thur. 8am-6pm Some Fridays
(707) 996-4585

Patient Forms

Click on any of the following links to open the form in your web browser or right click and save to download them.



  • New patient welcome form

  • New patient medical history form

  • New child patient medical history form

  • Authorization to transfer medical records


  • Dental procedures information and consent form

  • Patient insurance information form

  • Office financial policy agreement form


  • Dental implant consent form

  • Post op instructions for extraction or implant
Copyright 2013