Are you a hockey fan? Win tickets to a Kings game!
Dr. Yamada loves a good rivalry! Fill out this survey to enter the drawing.
Are you an LA Kings fan?
*
Yes
Not a fan (yet), but would LOVE to go to a game!
If so, who is your favorite player?
What is your favorite hockey team?
Patient Name
*
First Name
Last Name
Age
*
Under 18
18+
Parent Name (if applicable)
First Name
Last Name
Cell Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Okay to text?
*
Yes
No
Email
*
example@example.com
Visit us on Facebook
Check us out on Instagram
Submit
Should be Empty: