If you are a new patient to our practice, the attached forms are available for you to fill out in advance of your scheduled appointment at our office. Printing them, filling them out and bringing them with you will allow us to attend to your oral health care needs more quickly than completing them upon your arrival. Thank you and please call our office at (909) 558-4960 if you have any questions at all.
New Patient Welcome Letter
(New) Patient Registration Form
Medical History Questionnaire
Smile Analysis Questionnaire
Financial Policy - Patients With Insurance
Financial Policy - Patients Without Insurance
Financial Policy - Patients With Risk Management Insurance
Ortho New Patient Form
Pediatric Health History Questionnaire
FDO - Risk Management Summary of Benefits
CareCredit - credit application form
TMJ/Sleep Apnea Patient Forms
Orofacial Pain Health History Form
Orofacial Pain Evaluation Form
Sleep Apnea Questionnaire
Faculty Dental Office referral
Request for Patient Records
This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.
We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form.
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