EMERGENCY DENTAL EVAULATION
I understand the information disclosed in this form may be subject to re-disclosure and may no longer be protected by HIPAA privacy regulations and the HITECH Act. I understand that by hitting "Submit" I am opting into receiving text, emails, and phone calls relating to booking a dental implant consultation.
COMPLETE THIS EVALUATION TO
BETTER SERVE YOU IMMEDIATELY:
Someone will reach out to you right away to schedule an appointment
If You Need Immediate Care Call
(844) 763-3731
Also we can do a Video Evaluation here: https://app.smilevirtual.com/Avion-Dental/sign-up
Our Office is Located at:
4665 Chino Hills Pkwy Suite D, Chino Hills, CA 91709
