• Virtual Care Consultation Form

  • Live consultations may be used to manage discomfort or pain, visual trauma assessments, or follow-ups, or if you are trying to manage dental disease or engage in better habits at home and need more guidance or reassurance.

    *Prior to filling out this form* Using your phone's camera, please take at least 3 clear (non-blurry) pictures from different angles of the area of concern. Your camera's flash could be helpful to take pictures of molars or gingiva.

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  • *Important* For our Existing Patients of record who have been seen in our office in the last 12 months:

    • For urgent dental needs (trauma, pain, etc.), please contact us on our doctors' emergency mobile line:  949-478-2578  . Prior to calling, please use your phone's camera to capture and text us several photos of the area of concern.
    • For less urgent dental needs , please continue to use the form below to submit a description of the concern and your photos.
    • The $75 consultation fee will be waived.
  • *Note* We will help you to seek reimbursement from your insurance carrier or process claims once we return to the office, but please know this may be a non-reimbursable $75 consultation fee depending on your insurance policy and possibly used towards your exam frequency.

  • Attach 3 Pictures Below

    Using your phone's camera, please take clear (non-blurry) pictures from different angles. Your camera's flash could be helpful to take pictures of molars.

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