New Patients

For your convenience, we have our new patient forms available online! Click on the link below to access our secure new patient form and fill out the information using the instructions given.

Child Patient Form   |   Adult Patient Form
The latest version of Adobe Acrobat Reader may be required to access and submit our online new patient forms. If you experience problems viewing the forms, click here to download and install the Adobe Reader for free. MAC USERS:  Please note that you will need to view our online forms in Safari.
Televox

tel 562.430.0541
fax 562.598.0005
4608 Katella Ave., Suite 201
Los Alamitos, CA 90720


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American Association of Orthodontists
American Board of Orthodontics