New Patient Forms
Download the ADA Patient Screening Form
Please arrive at our office 15 minutes before your scheduled appointment to complete your new patient paperwork (which we keep to a minimum).
We also invite you to complete online (Adobe Acrobat Reader is needed), or download, print and complete our New Patient Forms before you come in.
- Patient Registration Form - view & download
- Patient Medical History Form - view & download
- Privacy Practices Form - view & download
Please send us your completed forms via fax, or e-mail, or simply bring them with you.
Please also bring your dental and medical insurance information.
- Call 310.458.8811 OR CLICK TODAY For An Appointment
What To Bring
Please prepare to provide the following information so we can better assist you at the time of your consultation:
- A list of all the medications you presently take.
- If you have dental and medical insurance, bring your carrier’s information.
- Completed Patient Registration Form, Patient Medical History Form, and Privacy Practices Form. They may be downloaded at the top of this page.
- Important: Please let our staff know if you:
- Have any sensitive medical condition(s) (high blood pressure, cold or flu, artificial heart valves, artificial joints, cardiovascular disease, diabetes, cold or flu, cold sores, etc.)
- Are currently on medications (antibiotics, pain medications, aspirin or any blood thinner, blood pressure medications, antidepressants or anti-anxiety medications, etc.)
- Are allergic to any drug or to latex.
Young People Need A Guardian Present
All patients under the age of 18 must be accompanied by a parent or a guardian to their initial visit.$99 Full Dental Exam & X-Rays*Cleaning is an additional fee depending on Periodontal diagnosis.
New Patients Only.*New Patients only. Must be presented at initial appointment.
Cannot be combined with any other offer. One coupon per person.
Make An Appointment
To make an appointment, call our office at 310.458.8811 or simply fill out the form below and we will get back to you shortly.
New Patient Forms
"My appointment was with Dr. Mashkouri & he saw me right on time. He greeted me with a smile, gave me great advice, was gentle, and did everything he could to make me comfortable. "