We have made it very easy for you to securely fill out forms online in the comfort of your own home or office. This will allow you to be seen in a timely manner at our office if this is done in advance.
We are an environmentally-friendly dental office that does not have physical charts or paper. We maintain a technologically-advanced paperless electronic dental chart.
Please fill out the form below to completion and submit it prior to your visit. Please allow about 15 minutes to fill it out. Dr. Amin relies on this form to help give you the best dental implant care possible. It will speed up your visit tremendously if this is filled out before your appointment.
NOTE: Fill out any random date if you are unsure of your appointment time in the mm/dd/yyyy format.
If you have ANY questions, please call us at 818-846-3203 or email email@example.com
If you are an EXISTING PATIENT OF RECORD please follow this link:
Reference Materials Required by Law For Patients