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Request an Appointment

Please fill out the form below and we will contact you with an appointment time. Required fields are marked with asterisks (*).

Patient Information

Name: *

Phone: *

Email address: *

Have you visited our office before? *

Yes No  

What is the reason for the appointment? *

  Regular Exam / Cleaning
  Specific Concern / Procedure

What concerns, if any, would you like to speak to the doctor about:

How do you prefer to be contacted? *

  Email   Phone  

Confirmation

 
 

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Office:

24432 Muirlands Blvd. #201 Lake Forest, CA 92630

Phone:

(949) 317-4884

Hours:

Mon - Thur: 9am - 6pm
Fri: Closed
SAT: 8am - 3pm
Sun: Closed


$89 New Patient Special
Includes Exam, Cleaning, & X-rays



Copyright © 2019 Jeanette Thai, DDS and WEO MEDIA. All rights reserved.  Sitemap | Links