If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival. Thank you and please call our office if you have any questions at all.
Patient Forms (Print & Complete All Forms Prior To First Office Visit)
Patient Information
Informed Consent of X-rays and Exams
Medical History
COVID Questionnaire
COVID Consent
HIPPA Acknowledgment
Arbitration Agreement
Financial and Appointment Agreement
Notice of Privacy Policy
This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.
Send Us A Message
We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.
245 North Glassell St., Orange, California 92866
(714) 532-5600
frontoffice@glasselldental.com