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NEW PATIENT FORM

If you're a new patient, to help expedite your in-office visit, please fill out, print and bring with you the following form. If you don't know the answer to a question, we'll be glad to help you!

Insurances accepted:
  • We accept most PPO and HMO insurance. We will work with you if you have no dental insurance
 Download Patient Form Here 

Give us a call if you have any questions or to schedule your one-on-one consultation with Dr. Sam. We look forward to meeting you at either of our convenient offices in Corona or Norco.
(951) 278-4646
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