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

IMPORTANT: We ask all of our patients to become a member of the Comprehensive Health Association. This costs you nothing to join, and protects your constitutional rights as a patient. The rules and by-laws of CHA are listed HERE.

The Comprehensive Health Association Membership Application form is at the bottom of the New Patient Questionnaire. Please make sure that you fill this out completely as well.

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.

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