Accessible Version
Daylight Dental
Dr. Aleeahna Phan, DMD

Patient Forms & Online Payment

Please feel free to download and complete the required patient forms, or plan to arrive 15 minutes before your appointment and fill them out at our office.

COVID Pre Screen

COVID Risk Consent Form Spanish

COVID Risk Consent Form English

Communication Release Form

Insurance Information Form

Medical History Form

Patient Information Form

Dental History Form

Authorizations & Acknowledgements Form English

Authorizations & Acknowledgements Form Spanish

Office Policy Form

Medical Information Release Form English

Office Policy Spanish

Medical Information Release Form Spanish

Cancellation Policy

Cancellation Policy Spanish

Pay Online

You can securely pay for treatments online, using the link below!

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (512) 782-8738
View the ADA Accessibility Statement

Smile now, pay-over-time at Daylight Dental!

We are excited to offer the financial plan Sunbit at our office now! Sunbit is a buy now, pay-over-time option for your dental services. Please click here to learn more!