Hercules Dentist - Douglas Lin D.D.S. - Hercules CA

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For your convenience, our new patient forms can be completed electronically or in PDF format. We look forward to greeting you!

New Patient Questionnaires

New Patient Form PDF

Medical History Spanish PDF

Medical History Chinese PDF

Now Open 7
Days a Week!

New Patient Offer

Welcome Dental Exam $1

Includes exam, full set of xrays

and treatment consultation.

(value of $250)

Welcome Back Dental Exam $1
Includes exam and FMX xray
With cleaning $91.

(Must be a patient who has not been in our office within the last two years)

Complete the form below by the deadline.

Offer expires: 02/08/2012

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<div style="text-align: center"><strong><span class="style1" style="color: #ff0000">New Patient Offer</span></strong></div>
<div style="text-align: center"><strong><span style="font-size: smaller"><br />
 </span></strong></div>
<div style="text-align: center"><strong><span>Welcome Dental Exam $1</span></strong></div>
<div style="text-align: center"><strong><span>Includes exam, full set of xrays</span></strong></div>
<div style="text-align: center"><strong><span>and treatment consultation.</span></strong></div>
<div style="text-align: center"><strong><span>(value of $250)</span></strong></div>
<div style="text-align: center"><strong><span><br />
 </span></strong></div>
<div style="text-align: center"><strong>Welcome Back Dental Exam $1<br />
Includes exam and FMX xray<br />
With cleaning $91.<br />
<br />
(Must be a patient who has not been in our office within  the last two years)</strong></div>
<div style="text-align: center"><strong><span style="font-size: smaller"><br />
 </span></strong></div>
<div style="text-align: center"><strong>Complete the form below by the deadline.</strong></div>
<div style="text-align: center"><strong><span style="font-size: smaller"><br />
 </span></strong></div>
<div style="text-align: center"> </div>
<strong>
<div style="text-align: center"><span><span style="color: #ff0000">Offer expires: 02/08/2012</span></span></div>
<span style="font-size: smaller"><br />
</span></strong>
<div><strong> </strong></div>

Please enter code above in the field below.

Hercules Dental Care · Douglas Lin D.D.S. & Associates
500 Alfred Nobel Drive · Hercules CA, 94547

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