New Patient Form

Please take a moment to familiarize yourself with the following information and complete the registration form. You can download the form, fill it out, and email it to us. Alternatively, please leave the social security number (#SS) blank and email the form to us. You can also fill it out, print it, and bring it to your first appointment.

This will ensure that our first meeting provides enough time for you to get to know our team and ask any questions you may have.

Click on the PDF link below to download the PDF form and complete it by filling it out, printing it, and bringing it to your appointment. If you have any questions, please don't hesitate to call us at 281-531-0710.

Download English Ver.(185KB)

Download Japanese Ver.(268KB)

As a courtesy, we will process your PPO (DPO) insurance benefits in our office, in our continued commitment to provide a combination of the highest-quality and most affordable dental care.

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OFFICE HOURS

Monday-Thursday: 8am - 5pm
Friday: 8am - 1pm

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