Dental Consent & Admitting Form

Phone number(s) where you can be reached today

Initial

Initial

I understand that with the removal of tartar during the teeth cleaning procedure broken or abscessed teeth, resorptive lesions or other periodontal problems may be uncovered. These findings may require further dental work that is beyond what was originally discussed. Please indicate your preference on how the doctor should handle any additional findings by initialing ONE of the choices below.

Initial

Initial

Initial

Initial

Initial

Initial

Would you like us to check other problems today or perform additional procedures? If so please indicate below.

Would you like a detailed estimate presented to you before any procedures are performed? Please initial your choice below.

Contact Info

  • Address:
    23431 Pacific Coast Hwy
    Malibu, CA 90265
    Get Directions
  • Phone:
    (424) 402-5100
  • Fax:
    (310) 317-4562
admin none 7:30 AM - 6:30 PM 7:30 AM - 6:30 PM 7:30 AM - 6:30 PM 7:30 AM - 6:30 PM 7:30 AM - 6:30 PM 8:00 AM - 2:00 PM 9:00 AM - 2:00 PM