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Welcome to Main Dental Center
As Benjamin F. Contreras, D.D.S., your health is our priority.
We have developed this survey system to provide you with the best dental care
and make your treatment process easier.
Privacy & Security
Your health information is protected in HIPAA compliant manner.
You can review and approve our privacy policy.
Time Saving
Fill out forms online before your appointment to minimize
your waiting time at the clinic.
Comprehensive Survey
Collect your medical history, allergies, insurance information
and payment preferences in one form.
Things to Know Before Filling the Survey
- The survey is completely secure and your information is encrypted
- Filling out the survey takes approximately 10-15 minutes
- Have your ID card number and contact information ready
- It will be helpful to have your insurance card with you
- You can use mouse or touch screen for digital signature
- You will receive a confirmation number after completing the survey