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.



CLICK HERE to learn more about the Cavilase Laser Dental Filling Procedure--
A better, more comfortable and healthier way to fill teeth!

Explore a better, healthier alternative to a standard root canal procedure!

CLICK HERE to find out about our Laser Nerve Treatment, a way to avoid root canals!