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

Medical History Form

Office Policy

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

We are excited to be OPEN again for all dental procedures. Our appointments will be limited due to high demand; however, please know that we will do our best to accommodate your needs for a dental appointment. If you have any questions, please contact us at (512) 782-8738 so we can assist you. Please click here to learn more about our enhanced COVID-19 infection control policy and the precautions and protocols we are putting in place to keep you and your family safe during your visit.