Patient Information

Please fill out these two forms prior to coming to our office. Thank you.


Patient Information

Medical History


These are the documents that will be presented to you to read at your first appointment. To save some time on your first appointment, you can read these ahead of time.


Notice of Privacy Practices

Patient Rights

Dental Material Fact Sheet Booklet

Consent for xrays, exam and cleaning


Our Office

Rancho Cucamonga

9220 Haven Ave, Suite 105,
Rancho Cucamonga, CA 91730
(909) 463-4190
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Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the contact form below.