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We ask our patients to fill out the forms below upon visiting our office. We provide the forms online for your convenience. Please feel free to fill out the forms and bring them to the office upon your visit to speed up the check-in process.

 Patient Registration Form

 Patient Medical History Form

 HIPAA consent


Park Place Smiles
641 W Route 66, D
Glendora, CA 91740
Phone: 626-226-1802
Fax: 626-914-2568

Office Hours

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