Victor Valley Endodontics
Victor Valley Endodontics

Patient Forms

New patient? Please download and fill out the following forms when you come in for your first appointment.

New Patient Registration Form

 

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.

New Patient Registration Form
V.V.E.Patient-Registration Form.pdf
Adobe Acrobat document [1.5 MB]

Patient Health Questionaire Form

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.

 

Health Questionaire Form
V.V.E.Patient-Health Questionaire Form.p[...]
Adobe Acrobat document [1.2 MB]

Privacy Notice

Please read over and sign our Notice of Privacy Practices, acknowledging our privacy policy.
This form should also be brought to your first appointment.

 

Acknowledgement of Privacy Practices
V.V.E.Acknowlegement of Privacy Practice[...]
Adobe Acrobat document [685.6 KB]

 New Patient Welcome Form

 

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.

 

New Patient Welcome Form
V.V.E.New Patient Welcome Form.pdf
Adobe Acrobat document [1.4 MB]

Informed Consent Form

 

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.

 

Informed Consent Form
V.V.E.Informed Consent Form.pdf
Adobe Acrobat document [1.4 MB]

Make an Appointment Today!

Call us at:
(760) 951-4646

 

Victor Valley Endodontics

17260 Bear Valley Rd

Victorville, CA 92395

Fax:
(760) 951-4647

Email:
frontdesk
@victorvalleyendo.com

 

Use our contact form to get in touch.

Office Hours

 

Monday - Friday
8:30 AM - 5:30 PM
Closed
Saturday & Sunday

 

Outside our regular business hours, please note our emergency care information.

Keep Your Teeth Healthy!

What is the best preventive care for your teeth? Find out how to make your next visit easier and more pleasant.

Print Print | Sitemap
© Victor Valley Endodontics