The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone 714.777.1890 or complete the appointment request form below.

For your convenience, you can also fill out the necessary New Patient & Health Questionnaires Form on-line.  Just click on the link below: (On-line informations are secured and handled confidentially.) 

https://www.orthoii-forms.com/HealthHistory.aspx?culture=en-US&custid=2999. 

Or if you prefer click below for PDF version to print, fill out, and bring it to your appointment.

https://www.orthoii-forms.com/OllHealthHistory.pdf

 

Our scheduling coordinator will contact you to confirm your appointment. Please do not use this form to cancel or change an existing appointment.


*Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Email:
Phone:  
Are you a current patient?
Best time(s) to call?

Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):