Call 714.777.1890
  • Yorba Linda, CA - 18611 Yorba Linda Blvd. 92886
  • Orange, CA - 1122 E. Lincoln Ave. Suite 210 92865
  • 714.777.1890 | Yorba Linda, CA - 18611 Yorba Linda Blvd.
  • 714.602.6430 | Orange, CA - 1122 E. Lincoln Ave. Suite 210

Appointment Request

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 online.  Just click on the link below: (online information is secure and handled confidentially) 

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


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.
Are you a current patient?


Which office location(s) would you prefer for your appointment?


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.):

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Please note: Friday and Late-evenings are by appointments only.  Thank you.