Dental Patient Forms
and Instructions

We’ll need the information on the forms below prior to getting started. Please download that form, complete it and bring it to your first visit. If you are not able to complete it prior to your first visit, please arrive 10 minutes before your scheduled appointment.

The forms are PDFs and require you have Adobe Reader to open them. (Nearly all computers have this. If you cannot open the form, you can download it here: Adobe Reader.)

New Patient Medical History Form

(PDF)
Click To Download ›

HIPAA Compliance Form

(PDF)
Click To Download ›

YOUR NEW SMILE STARTS WITH A PHONE CALL

Schedule Your Appointment

Click To Schedule ›

Dr. Ebrahimian and Team

Southern California's Premier Implant Center

CHINO OFFICE LOCATION
Chino Valley Medical Plaza
5632 Philadelphia St, Unit# 303
Chino, CA 91710
SHERMAN OAKS OFFICE LOCATION
13949 Ventura Blvd., Suite 250
Sherman Oaks, CA 91423
SANTA CLARITA OFFICE LOCATION
22817 Lyons Ave
Santa Clarita, CA 91710
OFFICE HOURS
Monday: 8:00 a.m. to 5:00 p.m.
Tuesday: 8:00 a.m. to 5:00 p.m.
Wednesday: 8:00 a.m. to 5:00 p.m.
Thursday: 8:00 a.m. to 5:00 p.m.
Friday: 8:00 a.m. to 2:30 p.m.
Schedule Dental Implant Appointment ›Schedule General Dentistry Appointment ›