New Patient Questionnaire


If you are interested in becoming a patient of Laser Dental Wellness Center-Fullerton, click on the link below for a PDF of our new patient questionnaire. Print it out, then fill in all the requested information. You can either fax it to us at 714-870-0153, or call the office at 714-870-0310 for other options.

Please be patient after you click on the link, as it may take a minute or two to download due to the large file size.

NOTE--You need Adobe Reader to view this PDF. If you do not have the current version, CLICK HERE for a free download.

New Patient Questionnaire PDF



Remember, after these forms are filled out you may Fax them to us at 714-870-0153, or bring them with you on your first visit.

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Copyright 2011 Laser Dental Center Association Laser Dental Wellness Center-Fullerton 1321 N. Harbor Blvd Ste 104 Fullerton CA 92835 714-870-0310, laserdental1321@gmail.com



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