Online Patient Questionnaire
Please complete the new patient questionnaire enabling our staff to prepare for your visit and make your check-in quicker and easier.
Our questionnaire consists of
documents. This process may take 10-15 minutes. Please note that certain fields, marked by asterisks *, must be completed. When you have completed a document, please review your entry and click the Submit button to move to the next document. Please note the information you submit will be encrypted for your protection and goes directly to our office. Thank you for your cooperation!
Should you have any questions, please call our office
or email to
To start, please click the
Irvine Children s Dentistry