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General Information

My dental needs or goals are:

Brief medical history

Have you ever had or have you been told that any of the following pertain to you?

Please list any foods or substances that you are allergic to:

Please list any medications that you are allergic to:

Please list any medication (Prescription or Over-the-Counter) that you take:

How would you describe your comfort level at the dentist?

Please see the diagram below and write the number of the teeth which are missing in the space

What do you expect from our practice?

When planning your recommended treatment should we take into account any of the following considerations?

Length of Stay:

Budget

XRAYS: In order to provide an accurate treatment plan and estimate it is helpful that we review your dental xray studies and oral photos

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Documents

Thanks for sharing your information; this will help us make a better estimate of your case.

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FREE TRANSPORTATION

If you are ALREADY receiving treatment with us, request our free transportation and relax. We will take care of everything, we´ll pick you up from your home or accomodation, bring you to the clinic for your appointment, and get you back to your home or accomodation.

  • Applies for patients in full rehabilitation
  • Applies for patients with scheduled surgical procedures
  • Applies for patients in aesthetic dental treatments

DOESN´T APPLY FOR
*First time visitors**
*Treatments without sequence*

SCHEDULE AN APPOINTMENT

+52 987 115 6045
+1 (619) 8787 965
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