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Office Forms

New Patient Form

This is a two page form. Please fill out all information and mail to:

ABQ Dental Associates, LLC
7930 Wyoming NE Suite A
Albuquerque, NM 87109

OR email to: 

new patient form
Notice of Privacy Practices

This form explains how we handle your confidential information. 

In an effort to cut down on paper waste it is not necessary that you print this form unless you want it for your records. It will always be available on this site. This form is to be read and if there are questions please do not hesitate to call.


Notice of Privacy Practices
Acknowledgment of Notice of Privacy Practices

Once you've read the "Notice of Privacy Practices" form, fill out and sign this form and email or mail to the address(es) noted above in the New Patient Form section. 

Acknowledgment

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Daniel L. Martinez, D.D.S. Copyright © 1997-2013

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