760-632-1304 [email protected]

New Patient History Form

Please be sure to click the Submit button once completed.

Please fill out the form below. Once Dr. O has reviewed your records, we will reach out to you by phone or email. Thank you. 

If you’re not in San Diego or driving distance of our practice, it is very difficult to provide dental treatment, unless you have friends and family you can stay with locally.

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. Please send all relevant imaging.

    Date Format: MM slash DD slash YYYY
  • This will help us to understand your unique needs and your situation.