NEW PATIENT FORMS

We look forward to meeting and helping you with your dental needs

In order to make your first visit a pleasant and an easy process,
please download, complete, sign and bring the New Patient Application and Office Financial Policy to your first visit at our office.
The HIPAA Notice and Dental Material Fact Sheet are for you to keep as reference if you wish.
Thank you!

Download New Patient Application

Download Office Financial Policy

Download HIPAA Notice of Privacy Practices

Download Dental Material Fact Sheet

BOOK APPOINTMENT

Thank you for requesting an appointment at Custom Smile Dentistry. This appointment has not been confirmed. One of our staff members will contact you by phone to confirm your appointment and obtain additional information to complete the appointment. If you have any question, you can contact us at (626) 355-2391 or customsmiledentistry@gmail.com

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55 W Sierra Madre Blvd., Suite 215, Sierra Madre, CA 91024

customsmiledentistry@gmail.com

NEW PATIENT FORMS

Download New Patient Application

Download Office Financial Policy

Download HIPAA Notice of Privacy Practices

Download Dental Material Fact Sheet

DENTAL INSURANCE

OPENING HOURS

CONTACTS

BOOK APPOINTMENT