Below you will find a registration form for your updated health information as needed. If you should have any questions regarding this form, please send Diana an email with your concerns. I will respond in a timely manner and answer any questions you may have.

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Click for Patient Registration Form

Click for Authorization Form

Contact & License Information


P.O. Box 264 | San Juan Bautista, CA 95045-0264 | Ph: 831.623.4585 |
Fax: 831.623.4350

RDHAP License No.

Calif. Lic #HAP00135

If you should have any questions, please don't hesitate to contact Diana Carr, RDHAP directly.

You may also contact me via email at: Smiles by Diana