Dental Hygiene 2 You

Mobile Dental Hygiene Services

Let’s Get Started.

Call us today at (626) 487-2354

Have questions about our services? We welcome your calls and are ready to talk with you and tell you more about what we do.

Three Easy Steps

Step 1: Download the 3 forms.

We have three easy PDF forms for you to read, sign, and return.

General Information for Informed Consent. This form contains a simple explanation of who we are and what we plan on doing when we perform our services. We need you to acknowledge that you understand our intentions and agree.

New Patient Information. This brief form is our way of getting to know you by gathering your contact information and a brief synopsis of your dental and medical history.

Patient Consent for Treatment. One more brief form that stipulates your understanding of our payment terms, and gathers your contact information, your insurance information, a HIPPA (Privacy Regulations) Statement, and permission to gather medical records from your physicians.

Step 2: Fill them out and fax them back to 626.593.2262

The information you give will supply us with the medical records we need, your insurance information, and your contact information so we can talk to you and schedule your appointments. Because we need your signature, a fax is the best way for you to return the form to us.

Step 3: Mark your calendar
for our visit!

We will call you back when the forms are approved and schedule your visit.

That's it! We look forward to getting started.
Download and return these forms:

Serving Southern California/626.487.2354