Before we begin any treatment we will have you fill out a medical history form so that we are aware of any medical conditions, medications, and allergies to medications. Having a thorough knowledge of your medical history will ensure that we can take care of you the best we can without any serious complications. Please fill out the form as completely as possible.

New Patient Form

Cosmetic Questionnaire


We will take a set of x-rays. Usually we like to take a full set of x-rays with new patients. If you recently had them done at another office you may bring those and if it has been more than a few months we will take a reduced set of x-rays. These diagnostic images are very important for us to be able to provide you a comprehensive oral evaluation. Visually we can only see the tops of the teeth but there is so much more to see under the gum and in the jawbone that only the x-rays can show us. We will also take a set of photo of your teeth.  This will enable us to share with you on your oral condition.


We do a thorough visual examination of all the teeth and other important structures inside your mouth. We look for any cavities, decalcifications (early indicators for cavities), oral cancer, tooth fractures, gum disease, and any other problems. We can also evaluate your bite and give recommendations on how to alleviate a sore jaw. If you are unhappy with your smile we will evaluate and give you the best recommendations on how to improve it. This is your opportunity to bring up any questions you may have concerning your oral health or smile. During this exam we will make note of any treatment we think needs to taken care of, talk with you about different treatment options and help you decide how to best take care of your dental needs.


During your appointment we will use special instruments to reach into every nook and cranny on and around your teeth to remove any calculus (tartar) buildup and plaque that has accumulated since your last cleaning. The dentist will evaluate your gum health to determine what kind of cleaning will best suit your needs. If it has been years since you’ve had your teeth cleaned then we may need to perform a more thorough cleaning, taking our time over 2 appointments to make sure everything is cleaned off.


If you have dental insurance please bring your information so we can process it and make sure everything you are eligible for is taken care of. We accept most PPO dental insurance plans. Call us to make sure we take yours. If you don’t have insurance then we take cash, credit, check, or we can set you up with a payment plan.

If you would like to set up an appointment for a comprehensive oral evaluation please call us at (626) 339-7012. Thank you!