Proudly serving Jacksonville, Florida, since 2006.

Our goal is to help patients reach and maintain maximum oral health by providing them with the highest quality dental care available.

Contact Us! or call us: 904-296-6820

Patient Forms

Martinez Dental Solutions Patient Forms

Schedule An Appointment · Jose M. Martinez, DMD

As a new patient to our office, you will need to fill out the forms listed below. They will be provided to you when you arrive for your first appointment, but you may also print them ahead of time and bring the completed forms with you. This will allow us to attend to your dental needs more quickly.

Thank you and please call our office if you have any questions at all.

Patient Health History Form - Child
Patient Health History Form - Adult
Medical Release Form - English
Medical Release Form - Spanish
Notice of Privacy Practices
Office Policies
Office Policies - Spanish
Financial and Appointment Policy
Financial and Appointment Policy - Spanish
HIPAA - Spanish
Phone Payment and Transfer Authorization
Phone Payment and Transfer Authorization - Spanish
Photo Release Authorization
Photo Release Authorization - Spanish

Contact Us or call: 904-296-6820

Contact Us!

Please provide as much information about your need as possible. If your need is urgent, please call us at 904-296-6820

Fill out my online form.