NEWPORT BEACH DENTAL CENTER

Jafar Assaf, DDS

Gina Assaf, DDS

1441 Avocado Ave, Ste 606 Newport Beach, CA 92660

PATIENT FORMS

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 Information

​​Medical History

​​​Dental History

​​Insurance Information

​​Authorization and Acknowledgements

​​Communication Release

​​Cancellation Policy Acknowledgement

​​Covid Consent

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