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New Patient Forms

Get Cozy At Our Family Dental Practice Who Proudly Serve the Ventura, Woodland Hills/Oxnard, And Other Communities.

New Patient Registration Form

Each form is available for download and can be completed prior to your visit. Our attentive team would be happy to answer any questions you may have, so please contact us if you need assistance.

COVID-19 Risk Assessment and Consent Form

I agree to contact Anacapa Dental Art Institute if I develop any of these symptoms within 14 days of my last visit to an office.

Medical History Form

Thank you for selecting our dental healthcare team! We will strive to provide you with the best possible dental care. To help us meet all your dental healthcare needs, please fill out this form completely in ink.

Insurance And Payment Policy

Our goal to each patient is to provide excellence in patient care and service, we ask that patients who do not have insurance pay at the time of service. We are happy to provide patients with financial arrangements using CareCredit or In-House financing if the need should arise.

Privacy Practices

This notice describes how your health information may be used and disclosed by our office and how you can access that information. Please review this document and sign the acknowledgement attached to this form.


Anacapa Dental Art Institute is the premier Oxnard dentist office for your needs, being the expert prosthodontist center that patients and even other dentists rely on for superior dental care. We are known for our state-of-the-art dental work and our professional, talented and caring team. If you are in need of any of our services, feel free to call to set up a private consultation. During this time, Dr. Jivraj will assess your condition and educate you on which treatment options are the best under the circumstances. In this complimentary consultation, we will discuss your dental health concerns and goals in a comfortable and relaxed environment where there will never be pressure for you do anything that you aren’t excited about.

(805) 988-3317

Dental Association

Our Team Looks Forward to Welcoming You to

Anacapa Dental Art Institute

We’re proud to help everyone achieve the smile of their dreams. We’re located in Oxnard and serve the surrounding communities including Santa Barbara, Ventura, Camarillo, Thousand Oaks, Woodland Hills, Simi Valley, Calabasas, Port Hueneme, Malibu, and Westlake Village.