Forms

New Patients | Existing Patients | Referring Doctors | Feedback



New Patients

Thank you for choosing Rafati Orthodontics! Download and print new patient forms below.

New Adult Patient Forms:

New Minor Patient Forms:

adobe These forms require Adobe Acrobat Reader to view. If you do not have Adobe Reader already installed on your computer, click the Adobe logo to download.


Existing Patients

Thank you for choosing Rafati Orthodontics! If you have visited our office previously, see below. 

Existing Patient Forms:

adobe These forms require Adobe Acrobat Reader to view. If you do not have Adobe Reader already installed on your computer, click the Adobe logo to download.


Referring Doctors

 Referring Doctors Forms:

adobe These forms require Adobe Acrobat Reader to view. If you do not have Adobe Reader already installed on your computer, click the Adobe logo to download.


Give us Feedback

In order to provide the quality of services you expect, we are open to your feedback and suggestions about your recent visit or experience with our office. If you have had an enjoyable experience, let us know. If you have had an unfavorable experience, please share your thoughts on how we might improve our services. Your feedback is valuable to us, and we will do our best to accommodate your requests. Please fill out the form below and include contact information, so that we may contact you to address any outstanding issues.

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Rafati Orthodontics

  • Rafati Orthodontics - 827 Blossom Hill Rd., Suite E2, San Jose, CA 95123 Phone: 408-226-1234

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