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MEET DR. BAE
Teledentistry Consent Form
New Patient Registration
Schedule Your Appointment Today
We are excited to see you! In order to best serve you, we have created this form to facilitate scheduling an appointment that best fits your schedule. Please complete all of the following questions. We will check our calendar availability and call you to coordinate and confirm a convenient time for you.
Are You a New Patient?
How Did You Hear About Us?
Referral from Friend or Family Member
What Type of Appointment Would You Like to Schedule?
New Braces Consultation
New Invisalign Consultation
What time of day do you prefer (Mornings or Afternoons)?
Preferred Day of the Week?
Would You Briefly Describe Your Situation? (Optional)
2700 N Bellflower Blvd #310
Long Beach, CA 90815