Health History

Please download the form below, complete it, rename the document to include your name, and upload it using the file submission area.Health History Form

Max. file size: 50 MB.

Get in Touch

Name(Required)
By providing a mobile number, I agree that Newport Beach Dental Center may send me automated appointment and dental marketing messages at the number I provided above. I understand my consent is not required for purchase.
Untitled

1441 Avocado Ave, Ste 606 Newport Beach, CA 92660

We Are Here For You