Patient Registration

Patients are encouraged to use online tools as much as possible to optimize safety. Once you sign up for an online account, from that point on, you will have online access in one convenient location to all of your family members’ dental  forms and account information. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.  Please note that Internet Explorer is the preferred browser for use with this software application.

PLEASE fill out all of the online patient registration forms BEFORE your appointment.


 If you are a new patient, please click the link below.

Help Instructions:

  1. Call 408-847-1234 to make an appointment (MM/DD/YYYY)
  2. Visit www.gilroysmiles.com.
  3. Select Patient Information.
  4. Select Patient Registration.
  5. Select New Patient Registration Forms.
  6. Enter your first name and last name.
  7. Enter the date of your appointment  (MM/DD/YYYY).
  8. Try to complete all forms in one session.  Your responses are not “autosaved”. Keep your window open, if you pause for a break;  otherwise, you will need to start over.
  9. Click Submit, in order to save your forms.
  10. For all subsequent appointments, you will have access to your account and forms through the Existing Patient Login. 

If you are an existing patient, please click the link below.

Help Instructions:

  1. Visit www.gilroysmiles.com.
  2. Select Patient Information.
  3. Select Patient Registration.
  4. Select Existing Patient Login.
  5. Select the Sign Up button located under Register Now.
  6. User IDs and passwords: 
  7.    a.  are not case sensitive;
  8.   b.   no special characters are required;
  9.  c.  IDs and passwords must be 4 (minimum) to  9 (maximum) letters/numbers
  10. Create your User name and Password (Keep these for future online access).
  11. A pop up thanking you for submitting your information will appear.  Within 24 hours you will receive an email/text noting your information has been updated with our office. 
  12. You can then access our website portal. www.gilroysmiles.com.
  13. Select Patient Information.
  14. Select Patient Registration.
  15. Select Existing Patient Login.
  16. Under the Secure Login, enter your User Name and Password.
  17. You will be taken to your account information (blue screen).  Select the forms tab and all of your forms will be there to complete.
  18. Try to complete all of the forms in one sessionYour responses are not “autosaved”.  Keep your window open, if you pause for a break;  otherwise, you will need to start over.
  19. Click Submit, in order to save your forms.

To Add A Family Member (Spouse or Child)

Help Instructions:

  1. Visit www.gilroysmiles.com.
  2. Select Patient Information.
  3. Select Patient Registration.
  4. Select Existing Patient Login.
  5. Select the Sign Up button located under Register Now.
  6. Add each family member separately.
  7. The easiest way to add each family member is to initially use their name as the User Name, (ie., Megan) and use 1234 as the Password.
  8. Complete the Patient Registration form and click Submit.
  9. Once your account request is received (usually 24 hours), we will link all of your family members together and you will be able to complete their other forms.  Note that once all family members are linked together, the guarantor or head of household’s  set User ID and Password will be used to access all family members through the drop down menu.

Contact Our Office Today...

Call us with any questions or to make an appointment.
 Gilroy 408-847-1234  Map & Directions