New Patient History Form

Please be sure to click the Submit button once completed.

Due to CASB guidelines, Dr. O must be able to evaluate patients in person. For this reason, he is unable to offer phone consultations for patients who live out of the area and cannot travel. More guidelines for out of town patients are here: https://myholisticdentist.com/out-of-town-patients/

Please be advised that Dr. O does not see children

More information for new patients can be found here.

  • Describe the pain: its location, its strength from 1-10 and how long you have had it.
  • Please e-mail current Xrays to [email protected]

    We request current Xrays so Dr. O can evaluate how best to set up your first appointment. If current ones are unavailable, we will take new ones.

    Date Format: MM slash DD slash YYYY
  • Has the treatment been done? Has there been any difficulties or complications with past treatment? This will help us to understand your unique needs and your situation.