Patient Forms

Click here to complete the online Health History Form (Secure)

  • Patient Form (Child) |
  • Patient Form (Adult) |
  • COVID-19 Form

Deals

  • Life Time Retainers (Limited time offer)
  • Essix Retainer
    • $500 down, 1 set of retainers included and next set at 50% discount on our currently price for life.
  • Permanent Bonded Retainer 
    • $600 down, lower retainer inclueded and 1 upper essix inclueded, next retainer at 50% discount for on currently price for  
  • Hawley Retainer 
    • $700 down, 1 set of retainer inclueded and next set at 50% discount on our currently price for
      Patient must to come to our office every 6 six month for new records. Fee may be applied.

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Los Angeles
(323) 600-5287
1127 Wilshire Blvd Ste 404
Los Angeles, CA 90017
Monday, Tuesday, Friday: 9:00am to 6:00pm
Wednesdays: Consultations and emergencies (10:00am - 5:00pm)
Saturday 9:00am to 3:00pm
San Diego
(619) 287-8870
6699 Alvarado Rd Ste 2202
San Diego, CA 92120
Monday, Tuesday and Friday: Consultations and emergencies
Wednesday and Thursday: 9:00am to 6:00pm