Dr. Michael J. Briseno, DDS
210.656.6362
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Forms

Here are a list of common forms that we will need filled out and returned to offer treatment.  You can also get these and fill them out the day of the visit.  However, if you have time to print them from here, you can save time at your appointment by having them ready to turn in when you arrive.  Please feel free to contact us if you have any questions. 
Info Page 1
File Size: 295 kb
File Type: pdf
Download File

Info Page 2
File Size: 367 kb
File Type: pdf
Download File

Office Policy
File Size: 81 kb
File Type: pdf
Download File

Notice of Privacy Practices.pdf
File Size: 79 kb
File Type: pdf
Download File

HIPAA Privacy Policies & Procedures
File Size: 47 kb
File Type: pdf
Download File

Health Information Privacy Policies & Procedures
File Size: 29 kb
File Type: pdf
Download File

Acknowledgment of Receipt of Notice of Privacy Practices
File Size: 129 kb
File Type: pdf
Download File

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  • Home
  • About Us
  • Treatments
  • Our Location
  • Forms
  • Our Reviews
  • Facebook
  • Contact Us
    • Schedule Appointment