Patient forms for dentist in Fresno CA – Family dentistry Clovis and Madera
Text Our
Front Desk Team Shoot Us
an Email 
5492 N Palm Ave Ste B
Fresno, CA 93704
 Read Our
5-Star Reviews Financial
Options
Call Us Text Us Email Us Map Us
Call Us
559-435-3113
  • Home
  • About Us
    • Meet Dr. J. Art Mirelez, Jr.
    • Meet Dr. Thomas Nguyen
    • Meet Dr. J. Eduardo Molina
    • Meet Our Team
    • Mission Statement
    • Tour Our Office
    • Areas We Serve
      • Fresno (Office Location)
      • Clovis
      • Madera
    • Insurance and Financing
    • Dental Technology
    • Patient Comforts and Amenities
    • Media
  • Services
    • Cosmetic Dentistry
      • Cosmetic Dentistry
      • Dental Implants
      • Porcelain Crowns
      • Porcelain Veneers
      • Teeth Bonding
      • Teeth Whitening
      • Botox/Juvederm Treatments
    • Dental Implants
      • Dental Implants
      • CeraRoot Implants
      • Mini Dental Implants
      • Implant Cost
    • Emergency Dental Care
    • Family Dentistry
      • Family Dentistry
      • Mercury-Free Dentistry
      • Periodontal Disease Treatment
      • Root Canals
      • Tooth Extractions
    • Gum Disease Treatment
    • Holistic Dentistry
      • Holistic Dentistry
      • CeraRoot Dental Implants
      • Ozone Therapy
    • Laser Dentistry
    • Orthodontics
      • ClearCorrect Invisible Braces
      • Six Month Smiles
      • Inman Aligners
    • Restorative Dentistry
      • Restorative Dentistry
      • Dental Crowns & Bridges
      • Dental Implants
      • Mini Dental Implants
      • Dentures
    • Root Canal Therapy
    • Sedation Dentistry
    • Platelet Rich Healing
  • Showcase
    • Smile Gallery
    • What Our Patients Say
  • Patient Info
    • Patient Information
    • Patient Forms
    • HIPAA Patient Privacy Practices
    • Insurance and Financing
    • Dental Technology
    • Patient Comforts and Amenities
  • Blog
  • Contact Us
    • Contact Us
    • Request An Appointment
    • Ask Dr. Mirelez

Patient Forms

Please print and fill out these forms so we can expedite your first visit:

New Dental Health Form
Medical History
Financial Policy
Insurance and Financial Agreement
HIPAA and Financial Disclosure
Three Levels of Dental Care

image/svg+xml
Ready to Get Your Smile Back?
Call 559-892-0015 today to schedule your consultation
-or-
Request an Appointment Online

Write A Review

Top Dentistry Clinics in Fresno 2016
Dr. Jose Mirelez, DDS has been recognized as one of the top Fresno Dentistry practices.
Verified by Opencare.com

Don’t Have Insurance?

Click below for more information about our Complete Dental Plan!!
5492 N Palm Ave Ste B
Fresno, CA 93704
559-435-3113

Contact Us



Instagram RSS-black Created with Sketch.
Fresno dentist Dr. Art Mirelez provides exceptional cosmetic dentistry, dental implants, sedation dentistry, holistic dentistry, general dentistry and so much more to patients in the Fresno, California area, including from the surrounding communities of Clovis, Madera, Selma, Oakhurst, Visalia, Exeter, Coarsegold, Lemoore, Sanger, Kerman and Coalinga, CA
  • Our Practice
  • Home
  • Meet Dr. J. Art Mirelez, Jr.
  • Meet Our Team
  • Tour Our Office
  • Accessibility
  • Privacy Policy
  • Contact Us
  • Request An Appointment
  • Patient Forms
  • Insurance and Financing
  • Popular Services
  • Cosmetic Dentistry
  • Crowns
  • Dental Implants
  • Dentures
  • Emergency Dental Care
  • Tooth Extractions
  • Family Dentistry
  • Gum Disease Treatment
  • Holistic Dentistry
  • Orthodontics
  • Root Canal
  • Sedation Dentistry
  • Teeth Whitening
  • Porcelain Veneers
  • Success Stories
  • Before & After Photos
  • Patient Reviews
Mirelez Wellness Dental © 2019 | Designed by DentalCMO | Internet Marketing by ProspectaMarketing

TEXT OUR OFFICE

Text message is limited to 160 characters.

HOW IT WORKS
  1. Enter your Cell Phone Number, area code first
  2. Enter your text message in the box.
  3. Click "Send Text"
  4. A copy of this text will be sent to the office and to your cell phone. The office's reply will also be sent to your cell phone where you can continue the text conversation.
Note: Mobile message and data rates from your cell phone carrier may apply.Close ClickToCall Button
cosmetic dentistry dental implants and sedation dentistry in Fresno Clovis and Madera

5492 N Palm Ave Ste B, Fresno CA, 93704 | 559-435-3113559-435-3113DrMirelez@MirelezDental.com

Mon-Thu - 7:00 am to 4:00 pm | Fri - 7:00 am to 2:00 pm

NagiosCheckValue - Do not remove please