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.

If you are using Safari for Mac or Google Chrome you will need to download, print and bring these forms with you to your first appointment. These browsers are not compatible with Adobe Reader and will not submit your forms to our office properly. We apologize for this inconvenience.

You may have a PDF Preview Browser Plug-in either installed or enabled on your system. PDF Preview Browser Plug-ins DO NOT contain all the necessary features that are required to submit forms online. If you would like to submit your forms online please follow the instructions below, these links may help you enable the Official Adobe Acrobat Reader for your browser.

1)Get the latest official release of Adobe Acrobat Reader


2)When asked make sure you enable Adobe Acrobat as your default PDF viewer
3)Make sure that you are running Safari in 32 bit mode
You DO NOT have Adobe Acrobat Reader installed and/or enable, if you would like to accurately view, fill-out, print or fill out our forms online please download Adobe Acrobat Reader

1)Get the latest official release of Adobe Acrobat Reader


If cannot submit the forms on line or if you do not want to download Adobe Acrobat Reader, please feel free to print our forms below, fill them out, and bring them into our office.
Child Patient Form (Print)   |   Adult Patient Form (Print)   |   Notice of Privacy Practice (Print)
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.
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